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HomeMy WebLinkAboutCLE201900001 Application 2019-03-25APPROVED by the Albemarle County Communit, !7�;,--'I-'-nont Department C E 2- Application for Zoning Clearan�. CL.E C L �i - I �, \(50<� q �uWf 75 ff� OFFICF, USF ONLY PLEASE REViEW AI,I, 3 SHEi;TS Check # CU Dnte: lteeript ti Staff: PARCEL, INFORMATIONSIC Alap and Parcel: 'SL f3 — ') 00 Existing 'lunint,_ Parcel Otvuer:—.V h>j -LY Ali Parcel atlrlresss-J ,s �`� `> cat I k�C �� (tf�A j (. Cite C R,1 p't%'S+�r��ar yt:ttc ZiL (include suite or floor) PRIMARY CON,rAC'I' Who should we call/write concerning this project." Address: I�'i xv i. t �C �v_�•� �Cityt"5,�.cii State V N 7.it��c -- _ _ f / Office Phone: (�) Cell N 'ruS S-1 `ri Fax tf E-mail 0AM tv61 14- N 1 -- APPLICAN`i' INFORIMATION Check an), lint apply: Chnngc of ovvncrship Change of use Change of name _IL'eIv business f3usincssNamrfl'ype: t> 7 t-i> t ars.OS L-4 G (imp. Previous Business on this site 0,L C NI-- V>C, 1%J Describe the proposed business including osc, number of employees, number of shifts, nvoilable parking spaces, number of vehicles, and any ar�Iitional infnrn,lion tint you call provide: Q��r��—%—c—»^�^—k- J � =.(r �' �- ��L�.� .r„r�y� �tj (,; �d..ti,� f.r_ at U.-e c--r� 1`his Clearance +sill only be valid on tiro parcel for tchich it is appro%ed. II )ou change. intensilj, or numv the use to a new location, a new Inning Clearance mil be required. I herehv eenify that I o-n or hate the imiivr`s perrnisaton to use the sparx tndicatcd on this appliceiuen i also eertir) that the inrormation provided is trYle and accurate to the he: of rnv k?�dge I buac read the cundiuons ot'upproval, and I understand diem. and that 1 will abide by them. Signaturc/ U, rr APPROVAL. INFORMATION ( ) .Approved as proposed f I Approved with conditions ) Denied ( j 13ackilow prevention device and -or current test data needed for this site. Contact ACSA, 977.451 1, xi 17. 1 j No physical site inspection has been done fear this clearance. Therefi>re, it is not a determination ofcomplianrr with tite existing site plan. 1 j This site complies with tic site plan as ofthis date. Notes: Building Official Zoning Official Of her Official Date /-1/4--/ 7, Mile r ` fir . Date . _ —1 ---f rnttttY rff iFifYti c wriment (if Community Developrifew 4 1 .11clnti e ad Ci t9ottesvill S : ti 02 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised I M12015 Page 2 of 3 Intake to complete the following: Y0 Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. / N Will there be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on private well o ublic wat . If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or ublic sewer? Y V N ill you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Wil ere be any new construction or renovations? If so, obtain the proper Permit. Permit # 7n—" *n thn fnllnwina- Reviewer to complete the following: l2in�gj: Square footage of Use: V Y/N Permitted as: e to f e4e4W ,1 Under Section: 75Z. Supplementary regulations section: Parking formula: ZV05 -It Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Viola�Pns: Y/qi If so, ist: Proffers: If/ Ifs , ist: Vari ce: Y / N) Ifs ist: SP's- Y / NO If so, List: Clearances: 2 0/7-7 Cf v lies �Clf•e1t�` (.ir T J SDP's 50ZV05 -IC?> S 0 P I It 7 - 011 5%�� fbOc�lYl C uN�KOw►� Revised 11/1/2015 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not tl:e owner. I certify that notice of the application, [County application name and number] was provided to If �Ij Wl-L- 1 N i')E -f 0I PG -�N C - the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel NumberCq�CID L1 7C1 QG�f00 by delivering a copy of the application in the manner identified below: 1---Hand " delivering a copy of the application to �`P Js d A- r r A — []Fame 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 office for that entity] oniZ12-1�ZC S Date Mailing 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 office for that entity] on 12-1T-1 ,Z o r ' to the following address: Date [address; written notice mailed to the owner at the last known address of the owner as shown on the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Signature of Applicant � 0 tu" crc1 Print Applicant Name 1Zjz7 Date �1 F 17 V t`. -�J l N � o V KY Parcel ID: 045CO-02-00-00400 Parcel Assessment Data (CAMA) Last Updated On: 12/23/2018 Other Parcel Data Last Updated On: 12/23/2018 GIS/Mapping Data Last Updated On: 12/23/2018 Summary Information Parcel Information Total Acres 1.07 Primary Prop. Address 1829 SEMINOLE TRL Other Address 1831 SEMINOLE TRL UNIT A 1833 SEMINOLE TRL 1835 SEMINOLE TRL UNIT A 1837 SEMINOLE TRL 1839 SEMINOLE TRL 1859 SEMINOLE TRL 1861 SEMINOLE TRL 1863 SEMINOLE TRL 1865 SEMINOLE TRL UNIT A 1867 SEMINOLE TRL 1869 SEMINOLE TRL 1871 SEMINOLE TRL Property Card(s) 2 Lot 00400 Property Name Woodbrook Shopping Center Subdivision Woodbrook Description WOODBROOK PARCEL B-4 WOODBROOK SHOPPING CENTER Owner Information Owner VANDERLINDE HOUSING INC Address 2820 HYDRAULIC RD SUITE 1 CHARLOTTESVILLE VA, 22901 Owner as of Jan 1st VANDERLINDE HOUSING INC Most Recent Assessment Information Year 2018 Assessment Date 01/01/2018 Land Value $1,119,700 Land Use Value $0 Improvements Value $114,200 Total Value $1,233,900 Most Recent Sales History Previous Owner EMPIRE MANAGEMENT & DEVELOPMENT COM Owner VANDERLINDE HOUSING INC Sale Date 04/17/2003 Sale Price $2,270,000 Deed Book/Page 2433/746 Other Tax Information as of Jan 1st 0 260 Scale 520 780 Albemarle lbemar9a County u Ay Tax Map: C Feet Woodbrook - The Gardens Business Condos _ T - Note: This map is for display purposes only / and shows parcels as of 1213112017. See Map Book Introduction for additional details. vl�- „U 077714 . �l l=""Ov Application for a Department of Health Foodservice Establishment Permit Application for a: Rr'NewEstablishment ❑ Renewal ❑Name Change ❑ ChangeofOwner Name of establishment: _ � U AS I fZn S Telephone: Mailing address: 1 �8 -)/ SC-M i vv o i- e TF-A i l__ Fax: C- AA RLC `7"T67S V 14 L E � � Z Z 1®% Physical location: 1 8 7/ 5 � h � � © i--C i/lA)L C44P-�-v7'-7ESVI1- -2- 7C)j Email Address: 14APyc✓ 6) EU 1� S+ 0-0.s N E ( Important forProduct Recaps& PublicHealth Emergencies) Establishment owner is a/an: ❑ Association P Corporation ❑ Individual ❑ Partnership ❑ Other Association, Corporation, Partnership name: -DS T /- -t� -b R A-t--� b S �, j- e- Names, titles & addresses ofpersons comprising the legal ownership (Attach list if necessary): FIJE�( M ,�y o12 GA 13p5 QcPJ Billing Address: ! S `]) � E�ti, f �j o ,�- Local registered agent (if required): Name Address Telephone aAfL-, C_ %V,4 2:Z5v/ Person directly responsible for the establishment: Name_ D P 6J I -- b M 0y o rL Title M "*I-i-' A Address 13 o S L A) C 14A2L-0 T7-t S cj r t; k C of j Z Z 1/o Telephone 3 V S - S I � - �> -7 4�,- Immediate supervisor of person directly responsible for the establishment: Name H ttl” E �( 0— 64 ��- Address .13 aS i-�Lp ,CA2 Telephone -:� a-S - 613 Z 7g (c� C ff/-\ft�-07`7:�- VILI-C VJ4 -72-`;,-)/ Is the food establishment: (check appropriate box) i2 Stationary ❑ Mobile Is the food establishment: (check appropriate box) 2Permanent ❑ Temporary (2 wks or less) ❑ Seasonal (months of operation ) Type: Full Service V Fast Food ❑ Take-out ❑ Caterer ❑ Hospital ❑ School ❑ Concession ❑ Other (please explain) Hours of Operation: Sun Monk' bn_ STues 6��QA�r Wed(-0aa SPThu4',0,+�fPFri�' Does the establishment: (check Yes or No) (1) Prepare, offer for sale, or serve "potentially hazardous food" (food that requires temperature control for safety — meats, cheese, soups, sauces, pasta, cooked vegetables, sliced fruit, etc.): 2 Yes ❑ No (a) Only to order upon a consumer's request: ❑ Yes Cv( No (b) In advance quantities: ❑ Yes 5Z No (c) Using time as the public health control (i.e., not temperature controlled): ❑ Yes eNo (2) Prepare potentially hazardous food in advance using a food preparation method that involves two or more steps which may include combining potentially hazardous food ingredients, cooking, cooling, reheating, hot or cold holding, freezing, or thawing: ❑ Yes Q No (3) Prepare food as specified under (2) for delivery to and consumption at a location off premises of the food establishment where it is prepared (i.e., catering): ❑ Yes fl No (a) If yes, is catering: ❑ Full Service ❑ Limited (4) Prepare food as specified under (2) of this section for service to a "highly susceptible population" (i.e. the elderly, pre-school aged children, or those with weakened immune systems): ❑ Yes C3rNo (5) Does not prepare but offers for sale only prepackaged food that is not potentially hazardous: ❑ Yes IRT-No (6) Prepares only food that is not potentially hazardous: ❑ Yes 21 No Number of seats: 3 0 — Number of outdoor seating: -- Q Water Supply: (check appropriate box) E2'Public — Name ❑ Private — Type Sewage: (check appropriate box) VPublic — Name ❑ Private — Type Uwe attest to the ccuracy of the info ation provided, affirm to comply with the Food Regulations and allow the regulatory a hority access toAhe stablishment at any reasonable time to inspect, conduct tests or collect samples as regu red. j' Signature: I Print Name: For Official Use Approved for Permit Date Signed: Date Issued: NrAM Title: ��€5 t OE -%— Date: i Z / 2-7120 / P Environmental Health Spec. Environmental Health Spec. Environmental Health Spec. This form contains identifying information subject to disclosure per the Virginia Freedom of Information Act (Virginia Code § 2.2-3700 et seq.) Revised 4/21/2017 ar COMMONWEALTH OF VIRGINIA VIRGINIA DEPARTMENT OF HEALTH In accordance with the regulations of the Board of Health of the Commonwealth of Virginia this certifies that DSTLD Brands LLC is hereby granted a permit/license by the Albemarle County Health Department to operate a Full Service Restaurant Trading as: GUAJIROS Located at: 1871 Seminole Trail Charlottesville, VA, 22901 Mailing Address: 1871 Seminole Trail, Charlottesville, VA, 22901 Conditions of Permit (if applicable); Date of Expiration April30, 2020 M. Reed Cranford,HS, CP-FS Environmental Health Specialist, Sr. THIS PERMIT IS NOT TRANSFERABLE FROM ONE INDIVIDUAL OR LOCATION TO ANOTHER New owners are required to make written application for a permit. Please Direct Questions or Concerns to the Albemarle County Health Department Environmental Health Services 1138 Rose Hill Drive Charlottesville VA 22903 (434) 972-6219 COMMONWEALTH OF VIRGINIA VIRGINIA DEPARTMENT OF HEALTH In accordance with the regulations of the Board of Health of the Commonwealth of Virginia this certifies that DSTLD Brands LLC is hereby granted a permit/license by the Albemarle County Health Department to operate a Full Service Restaurant Trading as: GUAJIROS Located at: 1871 Seminole Trail Charlottesville, VA, 22901 Mailing Address: 1871 Seminole Trail, Charlottesville, VA, 22901 Conditions of Permit (if applicable); Date of Expiration April30, 2020 M. Reed Cranford,HS, CP-FS Environmental Health Specialist, Sr. THIS PERMIT IS NOT TRANSFERABLE FROM ONE INDIVIDUAL OR LOCATION TO ANOTHER New owners are required to make written application for a permit. Please Direct Questions or Concerns to the Albemarle County Health Department Environmental Health Services 1138 Rose Hill Drive Charlottesville VA 22903 (434) 972-6219