HomeMy WebLinkAboutCLE200800168 Legacy Document 2013-01-30A'e, 4 S` )0 �1iD7C.IC >®�' X2.1 �5'�sz�/��e7�� L'G�s✓�i �' ✓�-
Application for Zoning Clearance
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CLE #
Zoning Clearance = $35
OFFICE USE ONLY
Check# 7 g Z Date: e919 t�
PLEASE REVIEW ALL 3 SHEETS-
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 722r 2!Odl / �' d`�'�'r ! Existing Zoning
Parcel Owner: S !y tG L�/� lU d // /� if`pI�6 .2 G-
Parcel Address: 10, 7 -36k5 City C41 �m�iT 1 Uf Atate y" � Zip°RRf4T
(include suite or floor)
PRIMARY CONTACT /
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Who should we call /write concerning this project?
Address: sal 6�'Ae tl // ��• City GJeI/ `� ' State
Office Pl ►one: !j l �`� � Cell # � 11 Fax #a2� � � E -mail %j�S�7ir�/�/%'% (P
APPLICANT INFORMATION
Check any that apply: Change of.owneiship . ✓� Change of use . Change`of name New business
Business Name /Type: -�0 %,�2���'G�e7C �Ofi� ?llLr'�/,����✓'�
Previous Business on this site
Describe the proposed business including use, number of employees, number of shif •s ava'lab�j parkf► g s aces numbe►• o
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vehicles, and any addit•oal information tl at on can provide: -Td `
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*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 thatthe information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, ann�d� I understand them, and that I will abide by them.
Signature a6z4z -." z lf� Printed e� l z S /�D� �)'7
APPROVAL INFORMATION
[ ] Denied
[ ] Approved as proposed [ Approved with conditions
[ ] 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 com/nrli�es with the site, plan f s of this date.
Notes �G�� V / 1,(1 Wet 4; ajA
Building Official Date
Zoning Official 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
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