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HomeMy WebLinkAboutCLE200900117 Legacy Document 2012-09-10Application for Zoning Clearance CLE # 'q - TI-4- Zoning Clearance = $35 OFFICE USE ONLY n Check # b Date: C� (f PLEA REVIEW ALL 3 SHEETS Receipt # Staff: c PARCEL INFORMATION Tax Map and Parcel: U qS C Q03 ® 1-S'©0 Existing Zoning tom. Parcel Owner: Como-; ® ��ti (C-� >t215 Parcel Address: 9 090 Gj✓� f2'���i11S (3LW City C t®1 41. C= State AC Zip _a�R - - (include suite or floor) *td I IG C - - - -- -- PRIMARY CONTACT Who should we call /write concerning this project? ) Address: 53 C: K("CL ut? , City CROCK -eRS State Zip q!�F6 (l3y Office Phone: U q79L -007 ®Cell # , Rq9_ $483 Fax # E -mail GA610 (: 9POs l'0 '33 APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business 310�S M)� (RZ"24 RVA Z �I& Business Name /Type: I At%fZ4,V7 Previous Business on this site ?,Q-S:t4Q 92a V i Describe the proposed business including use, number of employe number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: ACU?A OC-71_I VL 9-Y we-rH 44Wv-7" 10L 0 "'es r - s *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 bet f my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed APPROV INFORMATION [G ] Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119. [ ] 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 Zoning Official Date/ % /(f 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 Page 2 of 3 P � /W.C'927