HomeMy WebLinkAboutCLE201200192 Legacy Document 2012-09-10Application for Zoning Clearance
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OFFICE U NLY
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 73/1"- Existing Zoning
L29-
Parcel Owner: PGAhR5 G,C,+ �_L —
Parcel Address: 2005 Abbey Road City Charlottesville State VA Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Potomac Family Dining Group Operating Company LLC - Keith Litrenta, CFO
Address : 13873 Park Center Rd, Ste 316 S City Herndon, State VA Zip 20171
Office Phone: 2( 40) 752 -7578 Cell # Fax # 443 - 200 -1545 E -mail klitrenta @potomacdining.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: Restaurant
Previous Business on this site Restaurant
Describe the proposed business including use, number of employees, number A shifts, available parking spaces, number of
vehicles, and any additional information that you can provide: W) Obr.A I,S �0 Curl -tni- t)F— -e �J11lJ�o_vI
*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 t of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature G /0 Printed A:�--^27N L / R
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.
[ I This site complies with the site plan as of this date.
Notes:
Building Official Date
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