HomeMy WebLinkAboutCLE200700035 Legacy Document 2013-05-28a G -7- 3�5
Application for
Zoning Clearance
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El Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE QI�I,�Y J 3�
CLE # ;�CJ(��
Check #
Date: D%F
Receipt #
Staff:
PARCEL INFORMATION
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Tax Map and Parcel: q g �A Existing Zoning
Parcel Owner: N . o- /A t beyln(� (! t,
Parcel Address: q5$ 4, �n RD& 4, City State A- Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address A_b05 V N. M, l t—kx U City � V b �� State \Ak: Zi-
Office Phone: W l� 3-7 54 Cell # Fax #2%'76(S- E -mail JH 11CIGi VtC, & IC t Z-
Q v at li(t-0yQ
APPLICANT INFORM 4,TION
Business Name/Type: !dh4-5-fAr5 yl k ",b 7b l
Previous Business on this site ( 0.
Describe the proposed business, including use, number of e�yDI�oyees, tuber of shifts, availablg par Ong spaces and any
additional information that you can provide: tyDn". &� 1% l em . r Urge Big 1 1%(% d �
" — 66Lc — -i'0 C-a2efA" trIosWt .
*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 tleui Printed
APPROVAL INFORMATION
[. ] Approved as proposed [vfApproved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -45 11, xl 19.
[ ] 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: ..
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Building Official Date 0
1
Zoning Official Date �✓ (d
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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