HomeMy WebLinkAboutCLE201000029 Review Comments Zoning Clearance 2010-03-10Application for Zoning - _:Clearance-
- -
- - - Zoning Clearance = $35 . - - --
OFFICE USE ONLY
Check # �i . Date:
Receipt # cicwj2 Staff. J N 4
PLEASE REVIEW ALL 3 SHEETS
,/
PARCEL INFO" ION
Tax Map and Parcel: (� 06 -00 - yb �- Existing Zoning G
- TarceLOwner: -_ _._rQL4JJ�l� � D _._
Parcel Address: 1 lyt 4. 5-F£. di' City (94P -W S y) C.c-t: State VA Zip d�q63
(include suite or floor)
PRIMARY CONTACT �•/ ,
this ��' -� G. S_�__ r'
Who should we cal writ concerning project?
Address : 5 oh-e- City State Zip
gg
Office Phone: Cell # —' Fax # E -mail rA • iA
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: f11i4I�I'tk) '� NG . [Ali I rr 14117- 68 M M U N I CA 111W S
Previous Business on this site An -P i � � P (O M6
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehi les, and any additional information t at you can provide: weg `i ;4 Pz'
. VX& t Owe
*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 thaeIave the is pe 'ssion to use the space indicated on this application. I also certify that the information provided
is true and accurate of my o ledge. ve read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
OVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site: Contact ACSA, 977 -4511, x117.
[ ] 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 t / -- (C
\ I
Zoning Official Date
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, 10/13/09 Page 2 of 3
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