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HomeMy WebLinkAboutCLE200900129 Legacy Document 2012-09-10k Application for zZonime Clearance�� CLE# `/:Z °`� Zoning Clearance = $35 &VIEW OFFICE USE ONLY , Check # /U() — Date: r l C Receipt # '7 (.Q 0 (PL/ Staff: PLEAS ALL 3 SHEETS PARCEL INFORMATION 6l/ Tax Map and Parcel: —58) Existing Zoning / c Parcel Owner: �� %,' ffs Parcel Address:. o Tlp ZUy�i d"¢� SZ/17� /�, City �G� �� tate Ziw�?03 - -. (include suite of floor) - — - - - PRIMARY CONTACT f . Who should we call/write1c�oncerning this project' Address : �• 6 7�� City © r State V'I Zip �a g Office Phone: (�) Cell # 3 D°l X34 Fax # E -mail i�/SS� y�f I�D> APPLICANT INFORMATION Check any that apply: Change of opwnership9 Change of use Change of name New business Business Name/Type: �- %/�j�CJs ✓��-a� �/ / %/� �G(% ��j� �%�%GI�j�i Previous Business on this site %f R�s� G^Ll'i Describe the proposed business including use, number of employees, number of shifts, availa le parking spaces, number of �� vehicles, and any additional information that you can provide: l 5%' *This Clearance wilf 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, and I understand them, and that I will abide by them. Signature Printed � � �--T� �• �� �' .S 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, 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: Buildin g Official � Date Zoning Official r ." Date ��L) 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 Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit# - - -- Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Znnina to eamnlete the fnllnwin¢: Violations: Y/N If so, List: Proffers: Y/N If so, List: Variance: Y/N If so, List: SP's: Y/N If so, List: Clearances: SDP's Revised 04/28/08 Page 3 of 3