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HomeMy WebLinkAboutCLE200700044 Legacy Document 2013-05-28Application for Zoning Clearance o� Al, County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 511106 Page 2 of 3 OFFICE USE O 9 CLE # Z- % Zoning Clearance = $35 Check # Date: 'Z -Z Z •-0 7 PLEA E REVIEW ALL 3 SHEETS Receipt # Staff: PARCEL INFORMATION —06 Q Q Tax Map and Parcel: 0-5(0 01 " 310 Existing Zoning T-1 r -n�`^- kL Parcel Owner: tst Parcel Address: 'J6 (`1P %V%C'2e City CC04_�� State y 1. Zip UTQ, (include suite or floor) PRIMARY CONTACT T, _ 1 �`'1 11✓ �`LC>(.% Who should we call /write concerning this project ? �M Address: Si.O I E &n) 506 Itee 001Uhed R� City 'E' State VA Zip Ulip I Office Phone: Cell # Fax # gI4'ZZUlffl E -mail APPLICANT INFORMATION G �7i_P . s Business Name /Type: d Previous Business on this site 1j/A — mew ©�,V lce sw . Describe the proposed business, including use, number of employees, number of sifts, available parking spaces and any additional information that you can provide: Cif 1 C. rJ ., '40, � fit' z "�' . 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 best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature &4,4 At Printed' .e u kC (Yl a c cw, n APPROVAL INFORMATION Backnow Device and /or Approved Data Need [ ]Approved as proposed [ �/J with conditions C�prj;t�t [ �Backflow prevention device and /or current test data needed for this site. Contact ACSA, 97 `i�bjzt�L-J�CSA 977 -4511, x 119 [\ j-Xo physical site inspection has been done for this clearance. Therefore, it is not a determina .o oo ' e wit t e existing site plan. [ ] This site complies with the sLte plan as of this date. /! r �0 Notes: Pof 1 di,,6d A9 Building Official Date At t � a� 3 1" 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 511106 Page 2 of 3