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Home My WebLink AboutCLE201900106 Application 2019-05-29APPROVED l,v the Albemarle County, - e, N► Date Alication for Zonipu Clearance file. 5-2 � 1CLE # - (n �,l rtCtj��tB (ti2� - ,,`� i1 r , OFFICE USE ONLY !I o�� PLEASE REVIEW ALL 3 SHEETS Check # C� Date: r Receipt # Staff: PARCEL INFORMATION f �� iWw Tax Map and Parcel: ��-� Existing Zoning [ Gc�vvYV` Parcel Owner: s5y V \ Parcel Address: « � + City V L State VAN_ (include suite or floor) PRIMARY CONTACT 5E hl4 P PC� !`-(�+ / . Ll_)J,' EZ _ Who should we call/write concerning this project. Address: 64 G (OWNW0OfD C f City State Zip 22 JO/ Office Phone: l� -,6igo -c%/ 51-13 Cell �3332VX3?2 Fax # E-mail APPLICANT INFORMA Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: C9 F E COA/ L--EC1- Previous Business on this site CO 14:7 /Cr_ 4F— S1-fC /C" 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: 0WAJE& $Y 41" SELA-- s R )-r T e N L y ?d 30 Tv Z ° .3C --, w"-ff re 5s',4c,65 /N PRPJ=IAI c..c-T *This Clearance will only belvalil n 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 wner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best, of my kn wl . I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed �/u�� 0 �11}4-7-/Aj Z APPROVAL INFORMATION [ ] Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-45 11, xl 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 C� l Other Official C'ci UPI "plc 4 o Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 ('0"I Revised 1 l/I/2015 Page 2 of 3 Intake to complete the following: Is /� Is u I, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y /OWill e 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 wate ,... If private well, provide Hea panment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic Y N Wil ou be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y / 1� Will t ere 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: 1 N A�rmU"3 itted as: Under Section: 2 S A, 2. 1 Supplementary regulations section: Parking formula: y clzqu P Opt— $��z s Required spaces: Y/N Items to be verified in the field: Inspector Date: Notes: Viola p*ns: j If so,t: Proffers: If so, List: 2 Hif Zoo?-t3, 2606-( 2oay-iD . -loop>yy Vari e: Y( Ifs 1st: SP's: y/ If so, st: Clearances: 664 Z�16- zDo7-zSz SDP's 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 the owner. I certify that notice of the application, was provided to CLE 2-a(9-106 [County application name and number] [name(s) of the record owners of the parcel] and Parcel Number manner identified below: Hand delivering a copy of the application to the owner of record of Tax Map by delivering a copy of the application in the [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 know dress of the owner as shown on the current real estate tax assessment books or current real es ate ax assessment records satisfies this requirement]. Signature of A ,�5EKNAF-Do Print A plicant Name y )o Date Cafe Con I eche Food Establishment Inspection Report Albemarle County Health Department 1138 Rose Hill Drive, Charlottesville, VA 22903 (434) 972-6219 ___]Cafe Risk/Intervention Obs. Out of Compliance: Date: 20-May-2019 Repeat Risk/Intervention Obs. Out of Compliance: 0 Time In: 08:30:00 AM Good Retail Practices Obs. Out of Compliance: 0 Time Out: 09:00:00 AM Establishment Con Leche Address 515 RayC Hunt Drive Charlottesville, VA 22903 Telephone 0 295-0352 Person In Charge El certified Manager Permit Holder Cafe Con Leche, LLC EHS M. Reed Cranford, REHS, CP-FS Purpose of Inspection Routine Est. Type Other Food Service Priority Level Smoking Status Smoke Free Title 15.2-2825 Virginia Indoor Clean Air Act. In I Compliance with legislation. ........ ... FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Risk Factors are improper practices or procedures identified as the most prevalent contributing factors of foodborne illness or injury. Public Health interventions are control measures to prevent foodborne illness or injury. 1 In Supervisian Person in charge present, demonstrates knowledge & performs duties 16 Protection from Contamination (continued) In Food -contact surfaces: cleaned & sanitized 17 In Proper disposition of returned, previously served, reconditioned, &unsafe food 2 NIA Certified Food Protection Manager 3 In 4 In 5 In Employee Health Management awareness; policy present Proper use of reporting, restriction & exclusion Procedures for responding to vomiting & diarrheal events 18 19 20 TimelTemperature N/A N/A NIA Control for Safety Proper cooking time & temperatures Proper reheating procedures for hot holding Proper cooling time & temperatures 21 N/A Proper hot holding temperatures Good Hygienic Practices 22 In Proper cold holding temperatures 6 7 In In Proper eating.. tasting, drinking, or tobacco use No discharge from eyes, nose, and mouth 23 24 In In Proper date marking &disposition Time as a public health control: procedures & records Preventing Contamination by Hands 8 In Hands clean & properly washed Consumer Advisory 9 In No bare hand contact with RTE foods or approved alternate method properly followed 25 NIA Consumer advisory provided for raw or undercooked foods 10 In Adequate handwashing facilities supplied & accessible Highly Susceptible Populations 26 NJA Pasteurized foods used; prohibited foods not offered Approved source Food/Color Additives and Toxic Substances 11 In Food obtained from approved source 27 NIA Food additives: approved & properly used 12 N!O Food received at proper temperature 28 In Toxic substances properly identified, stored, & used 13 In Food in good condition, safe, & unadultered Conformance with Approved Procedures 14 NIA Required records available: shellfish stock tags, parasite destruction 29 NIA Compliance with variance, specialized process, & HACCP plan Protection from Contamination 15 In I Food separated & protected UOUD RETAIL PRACTICES Safe Food and Water0 Proper Use of Utensils 3urized 31 32 1 1 Pasteeggs used where required lWater & ice from approved source JVariance obtained for specialized processing methods i 43 144 45 In -use utensils. properly stored Utensils, equipment & linens: properly stored, dried, & handled Single -use & single -service articles: properly stored &used l Food Temperature Control 46 Gloves used properly 33 Proper cooling methods used; adequate equipment for temperature control Utensils, EOUIpmentl'and Vending 47 Food & non-food contact surfaces cleanable, properly designed, constructed, & used 34 Plant food properly cooked for hot holding 35 36 Approved thawing methods used Thermometers provided &accurate 48 49 Warewashing facilities: installed, maintained, &used; test strips Non-food contact surfaces clean Food Identification Physical Features 37 Food properly labeled; original container456 Hot & cold water available; adequate pressure Prevention Plumbing installed; proper backflow devices 38 Insects, rodents, & esent Sewage & waste water properly disposed 40 60dtamination Contamination prevod preparation, Personal cleanlines Toilet facilities: properly d, &cleaned Garbage & refuse properly disposed; facilities maintained 41 Wiping cloths: propred Physical facilities installed, maintained, & clean 42 Washing fruits & ve Adequate ventilation & lighting; designated areas used try = in compliance UU I = not in compliance N/O = not observed N/A = not applicable Received by EHS Page #1 of #2 Cafe Con Leche TEMPERATURE OBSERVATIONS 11 Equipment Temperatures Description Temperature OF 2-door low boy 40 Food Temperatures Description Type Temperature °F Milk Cold Holding 140 O12SERVA7IONS AND CORRECTIVE ACTIONS Correct the alleged violations cited in this Inspection report within the time frames stated below, as provided by sections 12VAC5421-3930 and 3950 01 the Virginia Food Regulations. The ROguiations Cary be viewed irr Food Safety at vdh.virginia.guv This Ins action Report sets forth the health department's observations, alleged violations, and recommendations for compliance, but it is not a case ci 'on as defined at Code of Virginia §2.2-4001. If you have additional facts you believe bear on this inspection and would like to schedult an inf rmal- ct finding conference (IFFC) pursuant to Code of Virginia §2.2-4019, please contact the Environmental Health Specialist referenced on thi inspec ' n report within fifteen days of receipt of this document. Should an IFFC be scheduled and you fail to appear absent good cause, the Vir inia De rtment of Health may issue an adverse case decision as contemplate by Code of Vi inia § 2.2-4020.2. This form contains informs 'on that c uld be subject to disclosure under Code of Virginia, §2.2-3700. ii �Z M. Reed Cranford, REHS, CP-FS Received By: Environmental Health Specialist SCHEDULING Follow-up Inspection Required: No Follow-up On or About: COMMENTS All facilities are required to have a Certified Food Manager by July 1, 2018 Health department grants approval for the change of ownership. Discussed with the new ownership about using the Dish€ achine and our three compartment sink downstairs to v<<ash, rinse, and sanitize food contact surfaces. Operator to to a good general cleaning of the facility. Received by EHS Page #2 of #2 NO cca r-F-a 3Kew E2. G � 1 t�Vv z z o/-'d 7-� �