HomeMy WebLinkAboutCLE200700028 Legacy Document 2013-05-22Application for `' N
LOW A
.Zoning Clearance
OFFICE USE ONLY '7
® Zoning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check # * Date: /1,3010 7
Receipt #
k--3, 7 `1 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 01 M)D00000 .o Existing Zoningtc- iG(4ppjR-I op
Parcel Owner:
G L41 & levy w a
Parcel Address: I ./1 m a
or
City CH ' V I U State VA Zip L c
]PRIMARY CONTACT
Who should we call write concerning this project? 6160 ;�� 7 .
Address: 1090 r►� 4� 1� V City [ VJ L/ State V /k- Zip CID 1
Office Phone: l.l_3 32�� Cell # Fax # � 7� E -mail (Aet Q1e 5i�a (R-�
APPLICANT INFORMATION
Business Name/Type:'Pwo. , CLW66 AJXV -6Y 4 AST4 "A iNG• (MC-N
Previous Business on this site qa M6
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information you can provide: g!CL 1 L� �1 � " �' Q
6V\- t w o-1 t c-
,n- ., . �, ,� r: — t - or, 17 to n in e) -t- 4 it OPT ni, (1 �T"LC�L -5 n cLr-e--
*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 conditios of approval, and I understand them, and that I will abide by them.
Signatu �� - -� —�- x Printed W
7,A ROVAL INFORMATION
pproved as proposed Approved with conditions [ ] Denied
[ ackflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x 119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site lan. Rackflow Device andlo>r
[7his site comp i s ith the site plan as of this date. Current Test Data Needed
Notes: t - a wv�c-�--3 2 za
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
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