HomeMy WebLinkAboutCLE200700014 Legacy Document 2013-05-22Application for
Zoning Clearance
Zoning Clearance = $35
OFFICE USE ONLY
CLE # 7,007 % J ;
PLEAS REVIEW ALL 3 SHEETS
Check# Upyzol of 43 Date: /-/:9-6-7
Receipt # 0376?7 Staff:
PARCEL INFORMATION i+ W, N
y
Tax Map and Parcel: 04500-00 -G� -� Q(p $ Existing ZoningC 6'Y E I (�
`
Parcel Owner: S()',(a S C l bt 0
Parcel Address:C\'C� �) i-- l VtOC� :)A � �KW rA City (A,V VA State Zip
(include suite or floor) -'
PRIMARY CONTACT n ',�
�U� t-2,-/M &,Aq
Who should we call /write concerning this project? \
Address: all° 6 bar'(•GtCK f,4 City (JV 6 40 -1kY&L State V I-1— zip atlD
Office Phone: (` V`f) ftj L1 -] Cell # 953- -�/7 1 )-Fax # qr��--¢ 55a E -mail h f 5\'• h C �l
APPLICANT INFORMATION/�J \,,
Business Name /Type: Q01 r �� V1 e� Y 1
��
Previous Business on this site
Describe the proposed business, including use, nu ber of employees, number of shifts, available parking spaces a���da�ny
additional information that you can provide: a SVl (CE/►� ,t1 r
l 1 •– �— � : 3 c� , a--S "�
*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 K�
Printed ���.
APPROVA INFORMA
[ Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[Vi 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
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