HomeMy WebLinkAboutCLE200900167 Review Comments Zoning Clearance 2010-01-26- Application for Zoning Clearance
CLE # - - -- -- - — - -
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OFFICE U S, Y
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Zoning Clearance = $35
Check # Date: -
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PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFO
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Tax Map and Parcel: Existing Zoning n
Parcel Owner: � —
State Zi
Parcel Address: City
(include suite or oor),�
PRIMARY CONTACT C'
Who- should- we- call/wr-ite- concerning this _project? /J
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Address �. /j{� 377 City/ 6h5 Lo State Zip
Office Phone: 3 f —d—cjk Cell # Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type:
Previous Business on this site r-
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: C', P10
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to anew location, anew Zoning
Clearance will be required.
I hereby certify that I own or have Pie owner's percussion to use the space indicated on this application. I also certify that the information provided
and I understand them, and that I will abide by them.
is true and accurat&ln the, e of y knowledge. I have read the conditions of approval,
Signature Printed%��—
APP VAL 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.
[L,j,nis site complies ith the site plan as of this date.
Notes: C&4
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Building Official Date �/
Zoning Official Date
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