HomeMy WebLinkAboutCLE200700083 Legacy Document 2013-07-10Application for
Zoning Clearance "
OFFICE USE ONLY
Zoning Clearance = $35 CLE #) �'-
PLEASE REVIEW ALL 3 SHEETS Check # ; Date:
Receipt # ro iy�) �' Staff: 4
PARCEL INFORMATION j�.
i /-
5713;'5 1 G ,2�
Tax Map and Parcel: j�✓! [o Q Pafcel S._ 51l/► � j57,A, Existing
Parcel Owner: S�- AV1y1PS (3e I Fi eld. S c�nool ,i�� A ��u� ()Vey)
VA Parcel Address: 2 3 2 V y City New oft C'S% �) t" State V A zip
(include suitef or floor)
PRIMARY CONTACT
Who should
wecall /write concerning this project? Kd b- Y) JyM u /1 e �-J
Address : , Sf � ✓ lU m
State VA zip 22-q05
Office Phone: (�t3`t) _�(A _ Cell # 61I -l943--) ax # u3l{-919 -H- 6&mail mb in , Y 0,uY)f- iCct? V0b,
nmSS.DrI
APPLICANT INFORMATION �J
Business Name/Type: Na-1 CA, N ,- � ' G O", S 1 e L-A OY
Previous Business on this site
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide:
*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 the best. of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature �1?/p1 8' e R1Ll�iAV�-P��t Printed ? t)6 n I "1 a Uklrl e�j
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions ['%V1 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.
[ ] Th' site go plies with the site plan as of this date3 �� "� M►\` °`e^A.t [�cQ
Notes: =A� /UGGt� -'—fV V4i 4 t h D r7V0 -N;n a P-e Kos . d AU, �t c,,��. Cds d1fe-1 Vln�t cuter
f�SPI I 4P" acf( -o-+f e6 VkM&ie -w.7
Building Official Date
Zoning Official
Other Official
Date
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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