HomeMy WebLinkAboutCLE200900192 Review Comments Zoning Clearance 2010-07-19r
Application -for Bonin C_ learanc -- -- _
- --
CLE <#
Zoning Clearance = $35
OFFICE USE ONLY
Check # Date: L�
'staff:
— -PLEAS REVIEW `ALI: 3 SHETS _
_Recei t #----- -l-o 4-
PARCEL INFORMATION
1 �y r' 111A Existing Zoning 11�
Tax Map and Parcel:
arcer wnP`_
Parcel Address: 1 �! S17City Adt,C`ttlit���/tate -.. - Zip's -Z"qo
(include suite or floor)
PRIMARY CONTACT /'
Who should we call/write concerning this project? `A�..�
Address • ci �� e.jc. ?t t0 City �$ wq,1e -- State V+ ! Zip
Office Phone: Cell #474- 531 2W6Fax # E-mail
APPLICANT INFORMATION
Check any that apply:: Change of ownership Change of use Change of name New business
Name/Type: d-�
Business
Previous Business on this site��
Describe the proposed business including use, number of employees, number of shifts, available arld aces nupher of
vephiecles, and any additional information that you can rovide: 1 hrr�
ti
*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 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.
'' j ✓�
Signature .--: /-A+ Printed
APPROVAL INFORMATION
k-fApproved 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 com)piiance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
r�
Building Official Date A ��
Zoning Official Date
Y
Other Official Date
t,ounty or Amemarie mepal L — . AL auu .T .,....,...Y..a..
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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