HomeMy WebLinkAboutCLE201100205 Review Comments Zoning Clearance 2011-12-15Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 15 2 Date: 12-13- I I
Receipt # PS [ bob Staff:
PARCEL INFORMATION r7 nn
Tax Map and Parcel: 32- � I FI Existing Zoning Ghf .0 Cann m�rUa
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Parcel Owner:
Parcel Address: '3444o.tftog 3&mi NU(,fACN City cl U,' 11 a State UA_ Zip 22q H
CCU"hlWo S (include suite or floor)
PRIMARY CONTACT CAS � � P6 � Cum
Who should we call /write concerning this project?
Address: 1 � Z" Ct L' City 3(4V3L-" o& State V A Zip 2c(ao
Office Phone: ` , Cell # 9041 15_'� Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use -Change of name New business
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Business Name /Type: 0_101r:`i540 41 3
Previous Business on this site
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: , ® =]'L� F-Mj2194. G ^
*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 accurate to the best of my knowledge. I have read the conditions of approval, I understand them, and that I will abide by them.
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Signature (// � ,,ay) M-`/" Printed i � d- 5 6 p— 3 A P, L°,6_f--
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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 1 ,�- t 41 f 1
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 7/1/2011 Page 2 of 3