HomeMy WebLinkAboutCLE200900130 Legacy Document 2012-09-10Application for Zoning oning Clearance_��
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CLE # �il.�T V9
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OFFICE USE ONLY Q
Check # %� Date:
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
(i�J( 49.
Receipt # -700ah Staff:
PARCEL INFORMATION��
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Tax Map and Parcel: Existing Zoning
Parcel Owner: !1�)1`6,Wg '� jA Ci'-/1(�\6 �t
Parcel Address: 2_60 � S l64e City (AP1S VL LIC State Zip -ZZ l
(include suite or floor)
PRIMARY CONTACT `' p
Who should we call /write concerning this project? [�
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Address: I3CJ6 � City CV WZi 5Y6 t State 0 Zip ZV63
Office Phone: U Cel #43 M -56�n5 Fax # E -mail Vl0- (@*k Pal4CVY t1e
APPLICANT INFORMATION
Check any that apply: Change of ownership Change use Change of name New business
/of
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Business Name /Type: _ � Ll Of (44 K l �! 1�:5 d 1z"
Previous Business on this
Describe the proposed business including use, number of employees, number of shifts available arking spaces, nimiber of
Cam=
vehicles, and any additional information that you can provide: C'c �� ttn� 4S (<35-
(:vim u Lk it��(t�e IlAc''�ifo(ZS � '{ @n 5 C 12xt2i . 'F� i� �'� w J G�i> 5. 1?0: k,!t
5PCces a 4'0— "1 �b i� .
*This Cl ar nce 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 acticuraflo 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
APPROVAL INFORMATION
[,,I' 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�� %�(i
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
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Circle the one that applies
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any land? If so, obtain proper
Sign permit.
Permit # - - -
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoninu to emmnlete the followinu:
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