HomeMy WebLinkAboutCLE201700024 Application 2017-08-31Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE
Check # 05 O L Date: i rf
Receipt # C R G_� Staff: t )S
PARCEL INFORMATION s (�
Tax Ma and Parcel:
P Existing Zonin
Parcel Owner: L � � C _
G
Parcel Address: City ^ StateV-A_zip]Q*
(include suitJ or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? cC
s j
Address: \ � City � �� _ State � Zip
333 7 Office Phone: ( 4 Cell # Fax # E-mail
APPLICANT INFORMATION
Check any that apply: of o ' rship Change of u Change of name New business
-LChange
Business Name/Type: T
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and a y additional information that on can provi '
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*This Clearance will only be vard 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 mmyy I have read the conditions of approval, and I understand them, and that I will abide by them.
/thebst 1knowledge.
Signature Printed 'tin N CQ_ c a
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ J Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xt 17.
[ I 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 D
JAW
Other Official "'"' ''f
"��Date
county of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/02/2015 Page 2 of 3