HomeMy WebLinkAboutCLE200700047 Legacy Document 2013-05-28I-
Application for
Zoning Clearance
Qe Ar.
❑ Zoning Clearance = $35
OFFICE USE ONLY
CLE # �d
Check# _�ZZ Date: `? 0
PLEASE REVIEW ALL 3 SHEETS
Receipt Staff: C k--\6(h0J C
PARCEL INFORMnATION�r��
Tax Map and Parcel: 'v [ SW -�'� -l1(G'dO� Existing Zoning
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Parcel Owner:
-
Parcel Address: 970 /7� �/V (d 14 City �.✓ State (� �- 1 Zips " /v
(include suite or oor)
PRIMARY CONTACT jig /G
Who should w/e, call /write concerning this project?
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Address : LU/ 0 �j L3f �� / � /�• City C VU-C State V /+ Zip
Office Phone:(/ )3Z Fax# W7Y/W E -mail l'm I MO h }(JJMQ✓ 6-S
APPLICANT INFORMAT ON -
Business Name/Type:Lf
Previous Business on this site
Describe the proposed business, including use, number of empI yees, number f shifts, available parking spaces and any
additional information that you can provide: Q1 r-o-ff-
*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 herebaccurate r have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true of m i wle ge. I have read the conditions of approval, a I understand them, and that I will abide by them.
Signat Printed ' r ( A&
APP,,R INFORMATION
•]OVAL
[.'Approved as proposed Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[t/rNo 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 pJan as of this date.
Notes:
Building Official Date
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
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