HomeMy WebLinkAboutCLE200800241 Legacy Document 2013-04-09- Application for -
Zoning Clearance
e
] Zoning Clearance = $35
OFFICE USE O Y Z, r
CLE #
PLEASE REVIEW ALL 3 SHEETS
Check # F 01D Date: P, `
- - -- - -- - - - - - -- -
- Receipt # -- - jn -11 - -- - Staff:
PARCEL INFORMATION
ii - Existin S G
� _ Zoning
Tax Map and Parcel: (, I g
Parcel Owner: 5 W- P("_Tt4
Parcel Address: Gov E, CC "', 30 City C tEA9L-T TKV41itState c - Zip 2.-.?9-,
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Y0512 P H M 1✓ LA-A S }{
Address: 0lid CObi-_DE N Cone," T *10/1 City fi Au -A 5SAS State VC1 r Zip 0109
Office Phone: Ina �ZS<�� l l Cell #3o 4ZS -Sn k )Fax # E -mail o ill �i (� �SOV -Cbi't
APPLICANT INFORMATION _
Business Name /Type: .S Q - NZG� P� S� J C\A K% S- (t`if� � �Cw � S
Previous Business on this site �: R 5 4 .S o N ek U R cv PO R e i m c- Liz i
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: CZ EiF .. �A UE S � 3 E +� P La y (: � S�� S � ��Z
i,r -,iNG L t2K a4
*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 1'� 211 Printed \ /oS
APPROVA INFORMATION
]'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_
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
511106 Page 2 of 3
1) 0
Zoninu- Tech to comulete the followinLy:
Violations:
❑ YES ❑7 NO
If so, List:/
Proffers:
❑YES /� NO
If so, Lt>`
Variance:
❑ YES P-,1 NO
If so, Lief:
SP's:
❑ YES /� NO
If so, List:
5/1/06 Page 3 of 3
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