HomeMy WebLinkAboutCLE201600197 Application 2017-04-21rl
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A placation for Zoning Clearance
OFFICE USE O LY
PLEASE EV[EW ALL 3 SHEET Check # n/A
Receipt #
PARCEL INFOR
Tax Map and Parcel:
Pa reel Owner: L,i/
Poreel Address:
PRIMARY CONS
Who should we call/,A
Address : y 7.1 r
Office Phone: 1(iv
APPLICANT INF
Check any that appl3
Business Name/Type:
Previous Business on t
Describe the proposed
vehicles, and any addii
Date:
Staff:
IATION _—
t'1 ib Fy - o Existing Zoning
S1 rJ, tty f1_QmQoL �S �j �0C7Ct lrr)rt
)—ja It a- L«n"_" City L.r01Q -f State L�
(include suite or floor) Ltp'
ACT / f %j
to concerning this project? /�/ t (�� �( a �.V Y)
CI 1-I C! S Il i IO City C f10 L Q it" State Zip J—,;
d - C Cell# -t IpS - Fax# olv,) - E-mail (k, hk6'�CCL�tll�%_t+
RMATION
Change of ownership Change of use Change of name New business
s site .SQ /Y12j
,siness including use, number of employees number Qf shifts, available parking spaces, number of
nal information that you can provide: i }
Q I S (. _
"T'his Clearance will only I o valid on the pqr el 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 r have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurst to the st of my knowledge. I have read the conditions of approval, an l understand them, and that I will abide by them.
Signature i /tt f Printed 77"J :4-- / i/r
APPWVAL INFO RMATION
[ Approved as propos d [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 I, x 117.
[ ] No physical site ins ction has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies w h the site plan as of this date.
Notes:
Building Official ,� Date
Zoning Official
Other Official
Date _ /_ 3 /-2 I ,
Date
County of Albemarle Department of Community Development
McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of 3
APPLI
This form r
Administra,
owner.
CERTIFICATION THAT NOTICE OF THE
XION HAS BEEN PROVIDED TO THE LANDOWNER
accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Determinations or Appeals, Sign Permits, Building Permits) i(the application is not the
1 certi that notice of the application, ` a r(ln . , �� i I -
[County application name at -Rd Umber]
was provided t MQ ' " f.. � p (jyno/ S /15S0(1 bZj-r) the owner of record of Tax Map
[name(s) of the orrdc d owners of the parcel]
and Parcel Nur iber 07 (pCQ - Qf - LiQ - (�QO O by delivering a copy of the application in the
manner identifi d below:
Hand delivering a copy of the application to
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient's
title or ffice for that entity]
on
�")Ct 1 1,29 and -
Mailing Mailin a copy of the application to , li P e S r d �n d t` w0 jy
[Name of the record 00hief if the record owner is a person;
if the owner of record is an entity, identify the recipient of the record and the recipient's title or
office fc r that entity]
QD lAkL -Ti-CL Lana,,t
[address written notice mailed to the owner at the last known address of the owner as shown on
the curreit real estate tax assessment books or current real estate tax assessment records satisfies
this requ rement].
Signature of Applicant
Print Applicant Name
AII(4_,,)q
Data)