HomeMy WebLinkAboutCLE200700046 Legacy Document 2013-05-28Applicati ®n f ®r
Zoning Clearance
OFFICE USE ONLY
Zoning Clearance = $35 CLE # a 00.
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PLEASE REVIEW ALL 3 SHEETS Check # i_ Date:
Receipt # '74S�_ Staff:
PARCEL INFORMATION
Tax Map and Parcel: 0 Li- 5 00 - 00 00 •- (p g .J�) �_ Existing Zoning t I T,4 CQ I')') ry-
Parcel Owner: Qc k .r i 1 ( fol-2� -E P 1 �U X11 d L -r.
Paf<ce),Address: ! cf 0 f 1� 1�orr l Nr I S City C /'1 V ► I E, State t�.l— zipz_ zq I
(include suite or floor) T—
PRIMARY CONTACT n
Who should we call/write concerning this project? e ¢ o N q
Address :1 Rai vv,, fen, r ,ctce Sue's /80City A4JaPJ State zip ,34--'O?
Of Phone: c77 b q 33- O o � Cell # 0q{ .37 �i,5,yq l Fax # ? 70 61,? -o pt o E -mail J e-ff - e R IZ
APPLICANT INFORMATION ) �1 II
Business Name/Type: _ 'De rx 61 e f Zee C a F f o y7 ec V ! 'e,
Previous Business on this site '--Do L -P-1 a Ti eS 0
pl-
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: ° Yl rn � QZ�U� ) S 7-�
*Thus 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 req ' , d
I hereby certify that I / or bav owner's permission to use the space indicated on this application. I also certify that the information provided
is true and ac c e t J best m knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
A WnYk Ac T r
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] 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.
Building Official Date 5 01
Zoning Official Date
Other Official �U-b Date 6
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fag: (434) 972 -4126
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