HomeMy WebLinkAboutCLE200700049 Legacy Document 2013-05-28Application for
Zoning Clearance
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= $35
OFFICE USE ONLY /
CLE # ca!��7'% `T
EI-Zoning Clearance
PLEASE REVIEW ALL 3 SHEETS
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C-� ir# Date. o - O
Receipt # Staff:
PARCEL INFORMATION
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Tax Map and Parcel: 'IGX bu 40-7? t Pc f-, \ 4-6', Existing Zoninu I IJ h
Parcel Owner:
Parcel Address: 5A-,4r !Pnrn City C�,o4o*5,& State Vi- Zip aa`il
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? J�
o, City Address: 1%�? 5�k Frry V\4 ILA_ State VIA Zip
Office Phone: (�13� G77l- 0000 Cell # Fax # (43y)ctl`t -1047 E -mail �ry,or;u �r�S�aSkcch 13 ter+
APPLICANT INFORMATION �+
Business Name/Type:
Previous Business on this site COmo\Gnw<cCM� G\MtC -CA syskcros r,c
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide: �prr�L}r r �jGr�iCeS a^�^ 1eA4k CCI� b" \ �u5brq
or �ie�J' 1 � tM �a tcS OV wrv\%mc availa
*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 t my knowledge. I have read the conditions of approval, and.l understand them, and that I will abide by them.
Teof
Signature Printed �SZSIzx� komis 1 Jr .
APPROVAL INFORMATION
[ ] Approved with conditions [ ]Denied
[ pproved as proposed
[ VBacicflow 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 comnlies with the site plan a this Backflow Device and/or
Notes: _ .-
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Building Official Date °l "P-1
Zoning Official Date
Other Official Date
County of Albemarle Juepartment of ommunity Leve1UP11iciiL
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
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