HomeMy WebLinkAboutCLE200700080 Legacy Document 2013-07-10Application for
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Zoning Clearance
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ES oning Clearance = $35
OFFICE USE ONLY
CLE #
PLEASE REVIEW ALL 3 SHEETS
Check # Date: t-I —6 �
Receipt # L o j Staff: - C)
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PARCEL INFORMAT�ION
Tax Map and Parcel: 1 13 11 Existing Zo in
Parcel Owner: f
Parcel Address• • Pi/ e 4v ,;dl City / State Zip =—= -`F—
(include Fite or floor) I /�
PRIMARY CONTACT
Who should we call/write concerning this project? '
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Address : �. V� ,A Dili O h:f City C1, jl C,Y� State Zips
Office Phone: G } % k)O Cell # 3,lo '2-5cl'_3
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APPLICANT INFORMATION .J /
Business Name/Type:
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Previous Business on this site F -' /
Describe the proposed business, including use, numb r of employees, umber of shifts, available pa king spaces and any
additib al i format•on that ou can provide: SG c
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*This Clearance will only be valid on the parcel for which it is pproved. If you change, ntensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I wn or have the owner's p iss' n to use the space indicated on this application. I also certify that the information provided
is true and accurate the best of mylkno edg . I h e read the conditions of approval and I understand them, d t at I will abide by them.
Signa Printed �S -�
Device and/or
AP OVAL INFORMATIO Data Needey",
�roved
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as ro osed t est
pp P p [ ]Approved with conditions �erg�i9?7 -4511, x 11`
[Aackflow prevention device and/or current test data needed for this site. Contact ACSA, 9
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[V.rI his site complies with t site Ian as of this da e.
Notes i6
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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
511106 Page 2 of 3
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