HomeMy WebLinkAboutCLE200800141 Legacy Document 2013-01-17, J7 -1 .
Application for Znnoning Clearance
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CLE9 ZGC�'— i�
omn ;CleArance 35
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USE ONLY
:Ch ck # 7q. 'Date.
API;EASE'JRE IE�V,;ALL.-3..S ''HEETS
'Receipt # T. i L/ Staff: �1 L
PARCEL INFORMATION /n �
//V z/0 � 0 G Existing Zoning
Tax Ma.p and Parcel: (y ✓
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Parcel Owner: 'v ✓" L a�.
����,, L),� 1 Parcel Address:/ q ( � 5a'J -'Ifif 1 P t�� City L . , " State IL/ c�� Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? 4' ,t -4 -14-r
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Address �% ✓ /Gr U Cit y State Zi p 1.Z� r r
y
Office Phone: (` / / } " Z/?' Cell # Fax # ey -�, ' Z/ h E -mail
APPLICANT INFORMATION
Chec1 {,anythat apply , ; �Change3ofownershipGhange ,of'use ' •. .Cliange-of +name New`busmes i
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Business Name/Type: ( •� 00Z 1414.-P 1414-,P) 41 X<10 / L 1- C. — k4ei ��-
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, 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 to the best of my knowledge. I have read the conditions of approval, and 1 understand them, and that I will abide by them.
Signature ���� '�t7L -� Printed �% fir: ✓' ��
APFRO`VAL :TN ;FORMATION r
[ ]Approved as proposed [ Approved wrth condttrons ie,iyArc ��#tj f oA
device /ox current test,data needed for this site Contactr�,CSA, 9 7�,� 9 "ate I�dt'c�
[ ] Backflowprevention and Cal', est D ,
] No physical site irispec ion`has beenzdoneffor thts clearance Therefore, �t4rs not.a:.determi ttgn:. �c�rr r et�rya�t ►gZexilIg
on
[ ] Thts site comp iertlt t; stte plan as ofahis date
'Notes GtNYI ` .+�. ttf A
.----
BuiI din g Office l �' Date
Zoning Official Date.
wt
:b.ther 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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