HomeMy WebLinkAboutCLE200900165 Review Comments Zoning Clearance 2009-10-07Application for Zoning Clearance-
OFFICE USE ONLY
Zoning Clearance — $35 Check # I Date: _ - " ,
PLEA VIEW ALL 3 SHEETS Receipt # Staff •
PARCEL INFORMATION
Tax Map and Parcel: -00-616 6 11 Existing Zoning
Parcel Address: t s �.� S CI City (i; U�d L .� State
V�- Zip
( �aG 1 r
include guite or flo4)
PRIMARY CONTACT 0
Address : I n, i •�•r°jl ��inC'� . _ city �` � ti � �� —State � Zip � � `
1
Office Phone: &-N) Cell # _26[e 53k, Fax # -11,135 E Q oil, l
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: J �L }
Previous Business on this site MC)0,P [ S !/t') (t__L. S V R. I
For
Describe the proposed business including use, number of employees, number of shifts, available parking spaces umber of
vehicles, and anj additional information that you can provide:��,
*This Clearance will only be valid on the parcel for which it is approved If you change, inters or move the use to anew-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 e be of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them _._._.
— — — ' --
Signature �LZ -7W% -� 17A At Z L ! b xi
Printed
APPROVAL INFORMATION
;4Approved 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 siteplan as of this date.
Notes:
Building Official Date —10 S �� 4D Q
Zoning Official Date (J / 7/6) %
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 04/28/08 Page 2 of 3