HomeMy WebLinkAboutCLE200700018 Legacy Document 2013-05-22Application for
Zoning Clearance
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"� OFFICE USE ONLY
°Zoning Clearance = $35 CLE # Zd Q•r%
PLEA ALL 3 SHEETS Check # Date:
Receipt # Staff:
PARCEL INFORMATION (�
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Tax Map and Parcel: ~
Existing Zoning �
Parcel Owner: f''`tc+�+� a �S�vG, GJ�-�c loro`�SSlp�k�)
Parcel Address: j w`f ��i City State �� zips
(include suite or floor)
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PRIMARY CONTACT J
Who should we call/write concerning this project? 9 r14`b GL, r STS /1, S� r/ ""
Address C -75 S v � ��"� °!l City C`i 4r Wk "``% State y` Zip" 7
Office Phone: CM) 3/1-1 Cell # -` Fax # SL9 15 E- mail ;,.-sti A
APPLICANT INFORMATION
Business Name/Type:
Previous Business on this site, C
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any,
additiopal information that you can provide:
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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-_kuewlcdge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature
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APPROVAL INF - - ' � TION
[ pppoved as proposed [ ] Approved with conditions
�Backflow prevention device and/or current test data needed for this site. Contact,
No physical site inspection has been done for this clearance. Therefore, it is not a
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
[ ] Denied
Current Test Data Needed
Contact ACSA 977 -4311, x 119
Building Official
Date
-�- I
S "'
Zoning Official
Date
2
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
5/1/06 Page 2 of 3