HomeMy WebLinkAboutCLE201100214 Legacy Document 2012-10-15I
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Application for Zoning Clearance
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CLE # 2 t i
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE O1YI�Y
Check# _ (0 +y Date: PrIO I
Receipt# Staff:
PARCEL INFORMATION
Tax Map and Parcel: _0 6 C�W -- 0 p o O -- d l ir' O Existing Zoning
Parcelowner:
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Parcel Address: S Z Loc-L. Sc, O Ci �e Xip �%
ty � Swfc -k- State y � Zip
(include suite or floor)
PRIMARY CONTACT 1 t
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Who should we call /write concerning this project? "z-
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Address : �� . City _ ICeS Ww��- State 1/' A-- Zip
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Office Phone: C__) 295'-1R/4 Cell #9 a6 -3 -703 Fax# E-mail G'XSrwDa -P
APPLICANT INFORMATION
Check any that apply: _ Change of ownership _ Change of use _Change of name New business
BusinessName/Type: ClS(V�O� t IY�0.��<< { / - S Coro �aS S tc f old
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, num er of
vehicles, and any additional information that you cap provide: C - S -to ooaL t Z S i 't}
*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 best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed (2 kl'L to
APPROVAL INFORMATION
,�t J Approved as proposed [ ] Approved with conditions [ ] Denied
[ J 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.
[ ] This site complies with the site plan as ofthis date.
Notes:
Building Official c Date zi (�
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Zoning Official Date a712d12-
Other Official Date Ob Jcin <-6 f
County of Albemm•le 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