HomeMy WebLinkAboutCLE200800098 Legacy Document 2013-01-11r
Application for � `yya
Zonin g Clearance�F.tNt� -`
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3
1
OFFICE USE ONLY
Cl
Zoning Clearance = $35-
CLE # 2-009—
PLEASE REVIEW ALL 3 SHEETS
Check # T/h.;3 5 Date:
Receipt # '703o15 Staff:
PARCEL INFORMATION
Tax Map and Parcel: Q (4 Q Ll ® D U0 O l `� Existing Zoning C "+)'
J �j'z.V k c�1.t
Parcel Owner: � � "- �W r►� I 4 M C_ LC_
Parcel Address: _3 Lt 4 1 df'1' "k". - _J V_ City C State Zipm it
(include suite or floor)
PRIMARY CONTACT
h\ �� ���
Who should we call/write concerning this project? Y cQ p i) , •1r
Address : 9 6L4 City ir, State . Zip
Office Phone: X777 317 1 Cell # gG0-s'7 2L Fax # E -mail.
APPLICANT INFORMATION
Cv'�e_X�J<z�
Business Name /Type: S )C--S
Previous Business on this site YY1t�a/ l r�,' 3 (S1%, I l Lk
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide:
*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 the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide byy them,
Signature Printed LA_ y-J
APPROVAL INFORMATION
[ ] Approved as proposed proved 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 comp ies with t site Ian as of t 's date.
`
Notes: W G(/Crc- �2 i ! -
VJ
Building Official Date
Zoning Official Date _ 4
Other Official �,�� Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3
1