HomeMy WebLinkAboutCLE201100119 Review Comments Zoning Clearance 2011-07-27Application for Zon4*ng Clearance
CLE # Z N
OFFICE ME QNLY
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PLEASE REVIEW ALL 3 SHEETS
Check # Date: W
Receipt # Staff:
PARCEL INFORMNW
Tax Map and Parcel: Existing Zoning
-
Parcel Owner: ` S60'
Parcel Address: �4i i& • �� City u �(A State U6 Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? >w-#
Address: �� e,,yA__ LC _k_ City XAL State Vft Zip
Office Phone: &2b 51:1—to '1 4 Cell # ��5 . ^'`a IG1.) Fax #,QJQ: dqt°' � E -mail Lo:tl ®r,.fO +k0 1'4�6 , Fail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: (a —' 6,
Previous Business on this site
Describe the proposed business including use, number of employees, num er of shifts, available parking spaces, number of
vehicles, and any additional information that you ca}� provide:i,�,
*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 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 accurjat o the best of knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Printed 14�j%'.4j L J, m, . �
Signature 1
APPROVAL 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 C, ( f ( t
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 1/1/2011 Page 2 of 3
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