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Home My WebLink AboutCLE201900038 Application 2019-04-16Application for Zoning Clearance �'`1``u� �t � yx CLE # �� 3� .>. PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY ry Check # IG4P Date: "[ Receipt # Staff: PARCEL INFORMA IO j� I Tax Map and Parcel:AExisting Zoning 1 V MD Parcel Owner: (I V131 l/ aParcel Address:-Uff 6Md St SWW'_' City State Zipi� �]J+� (include suite or floor) PRIMARY CONTACT TI Who should w((e,�call/write concerning this proje\ct?/� / r �/rt `/C50' Address: L I 65 ( V "� City V{ State V A Zip Office Phone: ( ) Cell e �Z �l'ity�ax # E-mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: e5 ✓ lc" I'L—if- Previous Business on this site Q a Ph � :�U 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: C{, G kojC2ll1 Z *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 that I will abide by them. is true and accurate to the best f my knrw4edge. I have read the conditions of approval, and I understand them, and that Signatu Printed /�/ {l e✓t LL GI�L�SGri /,( PROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, xI 17. [ ] 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'' Other Official CL(%{(� Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Jf )m Revised 1 1/1/2015 Page 2 of 3 Intake to complete the following: YN� Is in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. N ill ere 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 or pub ' wat If private well, provide Health f5erartment 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 pu �? Y / Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # WiT}Yhere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: I i .-;L- S Y// N 'ermitted as: (v� Under Section: (�� GSAi��`C� 1�/i�l� ✓t Supplementary regulations section Parking formulaic. -5 O0 D Required spaces: Y Items to be verified in the field Inspector : Date: Notes: Violations: Y / N If so, List: aWbA-A roffers: / N f so, List: Awl-7 ,-kW 8 -- 3 2Oj I, �1 .7 riance: /N so, List: — 's: /N If so, List:RO Clearances: SDP's - `� 7 - AO OF Revised I I/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 the owner. I certify that notice of the application, was provided to [County application name and number] [name(s) of the record owners of the parcel] the owner of record of Tax Map and Parcel Number by delivering a copy of the application in the manner identified 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 office for that entity] on 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 Date to the following address: [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 Print Applicant Name Date 411/2019 Inspection Report OMMonwealth Of Virginia — Department Of Agriculture I Food Safety Program IN TP 10 IN PO Box 1163 — Richmond VA 23218 — 804-786-3520 Retail Insfaection Re ort Firm No: 26580142 Firm No 0ECh:arIo�ttesvIlle, VA 22901 -Mna No; (941) 928-BO25 Phone a N . Purpose(s); Roubno wrier Inspection 10. 8599842 F Start: 0470112019 Writion violations: No of repeat Risk Factor/Intervention on Vlolatf NA -not aPPHCab—IONO=not observed COS=corrected on -site during jnspEER=re at violation� 1COSTR Compliance Status Approved Source nonstrateS knowledge, and 14 NA I Required records available::s ellstock tags, paras Idestruction agej Protection from Contamination 15 IN Food separated and protected and conditional employee; Id reporting 16 IN iFood-contactsurfaces;cteaned and sanitized 17 IN jProper disposition of returned, previously served, reconditioned and unsafe food ixdusion vomiting and diarrheal events I . , Time/Temperature Control for Safety Food Pro cooking time and terneeratures or tobacco use N"If 9 ff-r 'es for hot holdn2_ and mouth 1201 NA Prover coolina time and temoeratures L 9 IN reacsy-to-eat ioaa or a pre- —approved itirnaU,, pZoadure property followed IN Adequate handwashing sinks properly supplied and accessible 190 Approved Source IN M used; 461 IN MENTi M-1 surfaces used 1: 04/01/201 '5— s findings were discussed with the most responsible person at the firm at the time of the Inspection and this person was given the i d. A co p1ste copy of the Retail Food Establish ' ment Regulations for Enforcement of the Virginia Food Laws Is available at http. .[flaw. lt&vlrgtnia.,govWmincodeexpand/tMe2lagencWchapterBOS/ shiment (a stuire) iej Received By Title Neena'Selanki Sales ASSocate tor (S{gnaturel ajjt*CI "4A- 4 Allyn — - IF }cabwt,7777/gWjBwNC 240681/Ve?(g?p=123:,U35:3907870951450::::p'3435�_SYSINSPN :85 4/112019 Inspection Report Firm Name: GhpcolafasvEliE Firm No: 26580142 35 Bond ST STE 170 Charlottesville, VA 22901 Phone NO: (941) 928-8026 =ull Inspection Purpose(s); Routine Attention; Mary Ellen Isasomson,Owner StirtE(14/01/201 9 End. 0410�1/2019 No of Risk Factor/intervention violations No of repeat Risk Factor/intervention on Violations: 0 is tio. n.. 0 �' hysical Facilities, #52: 2VAr-5-565-2660 — Toilet room receptacle, covered. A covered receptacle was not provided in the restroom for sanitary napkins. 'Ya 's I—d.y"s findings; were discussed n and this person was given the Opp`o=rtunItyy-to- esp. espond. A complete COPY Of the Retail Food Establishment Regulations for Enforcement of the Virginia Food Laws is available at Establishment (Signature) http;/Ilaw.lis,virginia.gov/admincodeexpand/titio2lagency5/chapter585i 'Received By Title Neena Solanki Sales Associate for (Signature) Aftyn 00A),^ OA;"e4A— ""'-L'Y'N