HomeMy WebLinkAboutCLE200700065 Legacy Document 2013-07-10Application for
Zoning Clearance
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
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OFFICE USE ONLY /w
Zoning Clearance = $35
PLE XSE R EVIEW ALL 3 SHEETS
CLE # zoo---7 — &,5
Check # Date: a — —7
Receipt # Staff: ntQ
PARCEL INFORMATION
Tax Map and Parcel: no w i OA d iclAc) Existing Zoning Nmaleec t,..
Parcel Owner: ` jD98 06 &lll
Parcel Address: Z-24ED &Vi'y/1'1Df`1lt Z;V3,LT" DF- Cityebj9j2.L,bTj�&i/IL( &ate V,4 Zip.
(include suite or floor) Gj fTE C_
PRIMARY CONTACT
Who should we call /write concerning this project? ffi—,-LAf�60 G Kinkio=,
Address : Za6U ftmwnall ut -1 'ble- City [1k41qj21.C11f3&aL Mate \% Zip ZZRd1
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Office Phone: Cell #&W338113'S Fax # 4342411k30-mail _ Vote " to
APPLICANT INFORMATION
Business Name/Type: ,j.(�'� -C ' 4 (L LE i(jE-' Syi�Tl EM9, ~ VI4 5 LLB
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Previous Business on this site U�lKIV6WQ
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you,can provide: 1;5TK -I' 5a&1CV —Gzj1:U f il_151.1(2A -kCF .
*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 of my knowledge. I have read the conditions of approval, and I und'eerrstandd them, that I will abide by them.
,thhe�beesst hand
Signature �8� �a �r�d� � Printed ML4�14 C&jNh
APPROVAL INFORMATION
['•XApproved as proposed [ ] Approved with conditions [ ] Denied
1%. J acl(flow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[LNo physical site inspection has been done for this clearance. Therefore, it is not a determination of co� ' i .4
site plan. $ackflow Device and/or
[ ] This site complies with the site plan as of this date. Current Test Data Needed
Notes: 977-451
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Building Official .�-- Date • `mil-) o
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WW Date 0 I � k�
Zoning Official
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
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