HomeMy WebLinkAboutCLE200700025 Legacy Document 2013-05-22() t�7
Application for
Zoning Clearance
El Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE O
CLE # _ - J
Check # ixfD Date:
Receipt # Staff:
PARCEL INFORMATION > �J
Tax Map and Parcel: A ( 2 / /
Existing Zoning Z T
Parcel Owner:
Parcel Address: 5S _70 Su 1_C. 3
(inf]pd�eAS� e o ►�j ,�
w FJ�►
City CR_b2g -r State V -Zip ?-2-932-
PRIMARY CONTACT
Who should we call /write concerning this projecthwiity
Address: .0G 9& /� � / bs e �
�r// /p'
P f ec4Jk4f_10J State 1144. Zip �tl
Office Phone: U Cell #
Fax # E -mail 11V�4e r 13 P cw
APPLICANT INFQBMATI ,,,,//
Business Name/Type: �1Q V'G1�i�%�Y�A-�CJr?
— r
Previous Business on this site
Describe the proposed business, including use, number
of employees, number o shifts, v ilable parking spaces and any
additional' formation hat you can provide:
a4
a
*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 t I own or have the o erIs permission to use
is true and acc a to the best of my ' n wledge. I have read the
the space indicated on this application. I also certify that the information provided
conditions of approval, and I understand t em, and that I will abide by them.
Signature k
AP�tOVAL INFO TION
Printe 4_� ' e and/or
Current Test Data N ee ed
Contact ACSA 977 -4511, x 1i9
�[ proved as proposed [ ] Approved with conditions e
prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[Nckflow
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 1
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
511106 Page 2 of 3