HomeMy WebLinkAboutCLE200700015 Legacy Document 2013-05-22U�r
Application for
Zoning Clearance
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Zoning Clearance = $35
OFFICE USE ONLY
CLE # 7-00-7—/
PLEAS REVIEW ALL 3 SHEETS
Check # 91W201tV413 Date: 1 -1 R -07 � J
Receipt # lo-,3-7a-7 Staff:
PARCEL INFORMATION
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Tax Map and Parcel: 5f r D Existing ZoningC<S
Parcel Owner: S( )"M S C t
Parcel Address:qr�U : \ � K' City Ch Qu �V1�1k State
(include suite or floor
PRIMARY CONTACT n ' 1__\ K�6 tjWn A-,�
Who should we call /write concerning this project ?.
Address: -2U "16 bArCO� fA _�-9_ City C4� 4t�'!ti«� {� State
Office Phone: t (kM i? t./ 1 Cell # �J3Fax # �j,��l(¢ 55a E -mail 61YYIA
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APPLICANT INFORMATIOhN�
Business Name /Type:
Previous Business on this site
Describe the proposed business, including use, nu ber of employees, number of shifts, available parking spaces a d any
add'tional information that you can provide: Al(l S4'1 CLAII�
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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 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 41)t-14
Printed
APJPROVA INFORMA
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Bacicflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ j j,l o 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 ( �i
Zoning Official Date 8
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
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