HomeMy WebLinkAboutCLE200700031 Legacy Document 2013-05-22Application for
Zoning Clearance
y or nti�,t
Clearance = $35
OFFICE USE ONLYO
CLE
oning
#
Check # _1 1 ,•,L Date: 1 U
PLEASE REVIEW ALL 3 SHEETS
Receipt # _(L2 :7� (' Staff:
PARCEL INFORMATION
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Tax Map and Parcel: 61 a7 Existing Zoning 60r%,1hC✓'C,f Q46C r.,
Parcel Owner: ( e(oehS L--
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Parcel Address: ME5 A-y J✓Glvdt 1c..µ 5-14 �01_City �J,R ✓��v�i% State �� Zip -,Lg
(include suite or floor)
PRIMARY CONTACT p� ,k
Who /write r- ��✓ti"� "
should we call concerning this project ? /'ll
Address : 2-176 ;tti delw h' 4W SAC 11)a- City State Ilk Zip
Office Phone: (�Tt 878-3U1 Cell Fax # E -mail ih ► ��� �S y I ✓'hers _
APPLICANT INFORMATION �
Business Name/Type: h ,y
Previous Business on this site lxy-� 4 1CZ'_ — i�i (Il[r�' �• ✓rOP
Describe the proposed business, including use, number of employees, number of shifts, aAailable parking spaces and any
additional infor�mation that you can provide: [w��u4 - C�►+S„ Ft►y� S o tom_ t htoccve-
�'SCII�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 b st of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature ,P Printed /0i ke 13 C -Ceww +
APPROVAL INFORMATION Backflow Device and/or
[ Approved L] Approved
] as proposed [ with conditions �grr�gqn.44f less d Needed
[� A4ackflow device and /or current test data needed for this Contact A
7GC
prevention site.
lit A ' 7 -4511, 19
o physical site inspection has been done for this'clearance. Therefore, it is not a isting
site plan.
[ ] This site complies with the site �jlan as of this date.
Notes: &_a
A4f1j,v, AX
Building Official r Date
Zoning Official / Date r ly �r+
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
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