HomeMy WebLinkAboutCLE200700038 Legacy Document 2013-05-28Q-6 0 -7 -?) 3
Application for
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Zoning Clearance
_— - - --' OFFICE USE UNLY -
❑7.oning Clearance -$35 CLE# _-__..,._._.._.._......_.__.__._..__.—_-
PLEASE REVIEW ALL SHEETS Check# Date: - -, -
Receipt m— Staff: _ --
PARCEL INFORMATION
Tax Map and Parcel: wxyrON mij7pI.6 :5r -49p1— Existing Zoning -- .- . -. -._ -.-
ParcelOwner: AL EWlKL -I✓ CX QtJ -r`4 ___ -.. ...
Parcel Address: 21 R *l I.L. �� Cityii�i��ltfl flt✓r�lu State „ _ Zipz
(include suite or floor)
PRIMARY CONTACT rL
WhushouldwecaWwrite concerning this pr -o_je`ct? 7V I(srt �S {�T0�1_T�/
Address: 3CEI C Z� ST IJ" City l-•V1t2.1rt9' e% Ile State VAIr 7.ipu `1PZ'
f Office Phone: Lt* �L Ccll #qY4 -ZIZ 31r(� Fax # S �E -mail . Y 3 Vl ! 4}Lt • 2
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'APPLICANT INFORMATION
Business NamePfype: ti1't014T1CI LW V C W CLUB 1 (3 cYa-E Gl—u (3,
Previous Business on this site
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can rovide: lJ / 3
FFtC_Z&S CA tD avt =l2p M
.4 O T i Z r `6 1 J.
-•o police -6% C.t! fs Wn 4J- 710 QQc "- .
*This Clearance will only be valid on the parcel for which it is approved.
If$ou change intensify or move the use ht a new location, a uetv'Lonnng
Clearance will be required.
I hereby certify don I own or have the owner's permission to use the space indicated on this application. 1 also certify That the information pro% ided
is tme and aceura a to the hest of m. knowledge. I have read the conditions of approval, and I understand them, and that t will abide by them.
Signature r C tl /lvu�A /! Printed, V .I _ STo N 1= T-T4
APPROVAL INFORMATION
L j Approved as proposed [ ] Approved with conditions [ ] Denied
] Backflow prevention device and/or current test data needed for this sire. Contact ACSA, 977 -4511, x 119.
( ] Xo physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
( j This site complies with the site plan as of this date.
Notes:
Building 0f6clal - Date -1
Zoning Official Date A 1 1751--
Other Official •------ -_.._. _. Date - --...... .
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 9724126
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