HomeMy WebLinkAboutCLE201500084 Application 2015-05-22Application for Zoning Clearancerz�`'�7
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # !!'�c y 4� 1 Date:
Receipt # GA<'9 d Staff:
PARCEL INFORMATION
Tax Map and Parcel: � to '� • �l7 " oo , C% 1000 Existing Zoning
Parcel Owner: C0,r'v�4 Mr.✓i• •4 may. I 1 uPs >
Parcel Address: 3Liq r-0 N e t r .City V; Ik State VC Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? U nSL. C . Si.. -lr
Address: OL(e . CG -w• 6-c-1 l 0= A City (G.S W X CA ` State V c Zip �4 `-I 1
q2LI
Office Phone: Cell # 9t,0 -5-77,c- Fax # E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use - Change of name New business
Business Name/Type: 6- LV_ S
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available, parking spaces, number of
vehicles, 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 ormove 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 est of my knowledge. I have read the conditions of approval, and I understand them, and that I will by them.
1abide
Signature Printed C • S6_ 1
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117.
[ ] 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 complies with the site plan as of this date.
Notes:
Building Official �— Date
Zoning Official Date a��2�--�Z�15,
Other Official Date _5k17615
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of 3