HomeMy WebLinkAboutCLE200900159 Legacy Document 2012-10-01Application for ning Clearance
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OFFICE USE ON ],Y
Check # ��' Date:
oning Clearance = $35
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PLEASE REVIEW ALL 3 SHEETS
Receipt # G Staff.
PARCEL INFORMATION ) �7
Parcel: 1 �Ji Existing Zoning YDS(
Tax Map and /j ,
Parcel Owner: ��-
Parcel Address: 2 (eb P , s Cam; City L 'i�l>✓ State Lf Zip �/r
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(include suite or floor)
PRIMARY CONTACT • A
Who should we call /write concerning this project? P
Address : �� 5C rr LJcui City (�Ldo .State ULk Zip
Office Phone: L Cell ON'1 —53 5'Fax # E -mail 06i v�-6cyr le- ; C
APPLICANT INFORMATION _
Check any that apply:. Change of ownership Change of use _Change of name. New business
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Business Name/Type: f�� ��*tts� �j l�-Vcjin /1 1 ��C`#65- ill
Business ycl t ti bscl
Previous on this site
Describe the proposed business including use, number of employees, number of shifts, available arking spaces, number of
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vehicles, and any additional information that you can provide: e ts�G� $-
*This Cfflea-raQe will only b alid o the parcibfor which It is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required. i Z `
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 accuratp4o 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 ` 20(.VX--Q
APPROVAL TION
]'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 a 0
Zoning Official Gam" 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 04/28/08 Page 2 of 3