HomeMy WebLinkAboutCLE201100013 Review Comments Zoning Clearance 2011-05-25t�o�,� Chi only
Application for Zoning Clearance
=-_``�
9
17��pIIA
OFFICE US p LY
PLEASE REVIEW ALL 3 SHEETS
Check # ` Date: �` I
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Q'7 &V ; pp - CCU - 02 OAfD Existing Zoning
I � -
Parcel Owner:
Parcel Address: �c� �A I C 1%-A Zip
(include suite or floor)
PRIMARY CONTACT 1�
Who should we call/write concerning this project? (,-=a
Address:,;Z�?o C-:�Vot-W �,�,�Tis�i �/ 1 Cityl�4/. iAZL)al- State I-L Zi ff
Office Phone: 4- g ?7 000 Cell #7,6 ZSD394 -�5 Fax #
l� WV
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: yj1ZlT G NOU d!
Previous Business on this site �/� /n/7Zf/-/4A-QL
Describe the proposed business including use, number of employSes, number pf shifts, available parking spaces, number of
J� �mlylhLo�rc
vehicles, and any additional information that you can provide: ism
c t l-FI C6.,e,5
*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 tha o or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and acc a to best of lm f dge. I have read the conditions of approval, and I %gun /derstand them, and that I will abide by them.
�1�G—
Signature Printed
APP RO`V NFORMATION
"TApproved 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 �-d C(
Zoning Official z
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 1/1/2011 Page 2 of 3