HomeMy WebLinkAboutCLE200900156 Review Comments Zoning Clearance 2009-10-01Application for Zoning -Clearance
- CLE # w W fall
- OFFICE O LY
❑ Zoning Clearance = $35 Check #
Date:
PLEASE REVIEW ALL 3 SHEETS Receipt # Staff:
PARCEL INFORMATION .�
Tax Map and Parcel:
xisting Zoning IN z:q
-- rarcervwner- &_ .- v— A
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Parcel Address: _ A& [ � b City �6�` G� b State V Zip
(include suite or floor)
_.PRIMARY CONTACT p� j� ��
Who should we call/write
concerning .this.
� _State Zip Ci ��
Address t —o AV C' - c
Office Phone: (` A Lq2, Cell # ACk%l[—, Fax # E -mail dOUTNWSeaMWtl C�nA�lb
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use `Change of name New business
Business Name /Type: I' U S 1 C_
eriou�s Business on this site
Describe the proposed business including use, number of employees, number of shifts, available
vehicles, andAny additionallInkrination that you can provide: ^A e ` J 11
*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 knowle e. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature o Printed lr
APPROVAL INFORMATION
[ ] Approved as proposed Vf 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 com�pliy with theme ate plea as of this date.
Building Official / Date
Date J
Zoning Official / p
�(J Date
Other Official % v
County of Albemarle Department of Community Development
401 McIntir oad C rlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3