HomeMy WebLinkAboutCLE200900151 Review Comments Zoning Clearance 2009-09-25Application for Zoning Clearance
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OFFICE USE ONLY.. �}
.� Zoning Clearance = $35 Check # /% Date:
PLEASE - REVIEW ALL 3 SHEETS Receipt # - (p 6,,5 Staff:
PARCEL INFORMATION -
Tax Map and Parcel: r aas� i -cc) - c S - CX i O L) Existing Zoning
Parcel Owner: f. �'� G��'!: l�;,r.�� -.�• f-• ____
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Parcel Address: `RUC j, m11.n, �. P;(�,� City _ Vi State f! Zi p
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? L+k
Address: r? City C4_ rt'r � ' -C� State j )A Zip 22-gti
Office Phone: 4 -q 5,Tr7q Cell # Fax # zqS -cjq ( E- mail
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name/Type: L71eiy/✓��
Previous Business on this site -'
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
- Signature-
APPROVAL INFORMATION
[,.'Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date
Zoning Official — Date x6 �� A 9:
Other Official Date
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401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3
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