HomeMy WebLinkAboutCLE200700043 Legacy Document 2013-05-28Application for
Zoning Clearance
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OFFICE USE ONLY
oning Clearance = $35 CLE #
PLEASE REVIEW ALL 3 SHEETS Check# 11 4qq Date: Z-ZZ -0-7
Receipt # 1v 4 a a l Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning PDS C ,
Parcel Owner: PGt.t t l Oc l dr6ri i, A n
Parcel Address: I r140 R to 14, [ 1 &_ntcr City C earl o �eSV°i �. State V Zip .W9 01
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? Ka m be -c s -- F-1`Zla 11C
Address : P. O.3 o w 50 Li City L ocord State N C, Zip �W a(c
Office Phone: `y( LA) IV loW Cell #
Fax # VP488 -7651 E -mail CeAb jm. b'i 2
APPLICANT INFORMATION
Business Name /Type: 1 Y+eY - orY 14outSe o PQyClaL� l
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Previous Business on this site oo,� known
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: 1140C i-
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*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best o my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed (
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APPROVAL INFORMATION
[V "Approved as proposed [ ] Approved with conditions [ ] Denied
[ 4 j$ackflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -451
[ V?No physical site inspection has been done for this clearance. Therefore, it is not a dete a R&W16' exis 'ng
site plan. Current Test Data Needed
[ ] This site complies with the site plan as of this date. Contact ACSA 9 j'/.4$11, X 119
Notes:
Building Official Date -a-
Zoning Official Date �� 7
Other Official Q��� ��1�0'1/ chi Date D
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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