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HomeMy WebLinkAboutCLE201900104 Application 2019-06-10APPROVED Application for Zonin Clear 'diFt�p 111 ent CLE # C E 2 Ct 5- PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY i Check # Date: Receipt # ' Staff: PARCEL INFORMATION Tax Map and Parcel: lyl C) C>3146 Existing Zoning N M Q Parcel Owner• % f�ltf j�Xn U—L 5 k ; p Parcel Address: e L,, City Cit"(z, 5Ake State t+ Zip 2)`SL (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? 11i'' Address: �r✓ �Uk L�Cj6 city�(M(uii25y)I State YI7 zip 2ZgtZ Office Phone: ( ) Cell # '7a3 y 'StO'L Fax # E-mail �;fv i ��.� •vs►'Y� APPLICANT INFORMATION Check any that apply: Change ofownership Change of use Change of name Jim New business Business Name/Type: t, Previous Business on this site /� I Describe the proposed business including use, number of employees number of shifts, available parking spaces, number of vehicles, anll any additional information that you can provide: Cs P� sl�c, r 2- � � wnelo e", T ��, +� Z Sh•� S_Pe_A-, Z-3,.eLt,c1�-3, `b ks(uYr� aco� c�(lece *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 is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. ure Signat) — a� Printed_ 7-ri'ZH�I.-A ix(r-i AP %OVAL INFORMATION Lf Approved as proposed ( J Approved with conditions Denied ( ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117. [ ] 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- 00, Building Official Date / %q Zoning Official Date - / Other Official i1 nV 1 Date (� 6 County of Ainemarle luepartment 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 Intake to complete the following: Y // i Is LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y/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 nblic�ment If private well, provide Heap form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appli Is parcel on septic or, nblic sewer Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # 'Y�/ N -rill there be any new construction or renovations? If so, obtain the proper Permit. Permit# 132©IQ —D11 `fL(-AC Zoning to complete the following: Reviewer to complete the following: Square footage of Use: (1 Oo Y PN I / ermitted as: Under Section: 1 O �• �S�G �c� t� d t"rq zl-i%12Olt -l7 a Supplementary regulations section: Parking formula: C 1 hYCI C Cn"t Required spaces: Y/N ns: Y Vi3st: If Proffers: Y/N If so, List: 2 PA z 1,l6- (Z2 0 (S - D3 Varii Y/ If so, st: SP's• Y/� If so, List: / Clearances: 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, o t ( [County application ridme and number] was provided to 'D �\o Rs the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number d o-7 (l(70 - c0 i - DpA by delivering a copy of the application in the manner identified below: ® Hand delivering a copy of the application to �kbkl 6j 1,re3( LLC-� [Name of t e 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]. -g-naatture of Applic Print Applicant Name Date o Scale: 114" = V-O" 06/06/2019 10:42 9724310 #4039 P.001/001 II] 8.9i GtSon ...,a�o�pCs.wi.CaarlalfoNa\ t1�ae7M t�IftT1Uf7T ilYwnl\ au..,\ LsYlit r4ta�n Foodservice Facility Plan Review Evaluation 139 Rose Hill Drive Charlotte ale, VA P. O, Box 7346 Charladtaaville, V( . Phons: (43,0 972-62. Fes: (434) 972-6221 sbould I eoatact the B allb mpvfmcat when openlne a new cmbllabaoeat or wben rrllIng or tranafarrist owne aldp *tow nabarantt 'k Health Depabaco ahonld be oar of the fun "des caoumd Numow a chmp of trwaa ft or eaaetnubioa of a new fadlhy bwou& Rrapuw= is art now4mtstbable, ne Mgbdo Fbad rrqu4a dun for nsw owoa lnbmlt a plan rtvit� Gal far a Ira>wam pack tboe p}am as this Am wlil be subadtttd m the local buQ�iutF Tly pllotvtu� lt�a to laluo yam bupol»� pmoh toed btaa►r�l Ifcrmso. Fwtatnotq, a nee Pia` rough in �fl iaV"un is mqubod prior m iawina ■ pemit to the new alma, an HOW soon CV0 I open alta- I submit a "ehaappe of owng"ItIp' appaesdaai 7be luuwca of a new parent mry Brat rdgWm *ubowdlal �tP rcnovtdpom and upprada It h rarmm mdpd Out dw owner and prospredve hWar rubmh paparwwk oMsed below and tbea eaaage ao bupa goa with the He" Ikpwmuv m ammm tf tbcm are Waadet to the apkwKw Or fUllty thal will be bed pttor 10 RSA a Drw ptrmi L Why We I (the pear owner) blot defied ■ permit, wben tke previous fttcIft owner had bean to bvalrum fbry=n? The V016Uo Fmd Rephdg u an bNumdy bola{ updated Wbm a rcaEattrant undapa a cbmp of ownmWp, the fa -Z* Is Ihen treated u a brand new atabllabtnwt Subscguady, the ibaiy mart prat meet rubMatid a mptbmes with do arose aurmtt vaalon of16o ub&b Food Repitdadtms before a pammi be i -ed (nee Qte Pr-i= gUUAD4 How can Iobtalo s copy of the current version of the WT/n!a FardRegaigg ert A Ihdled wenba oleapla are avWMo for pt nhue as yoga local baWth dcpwftmt ofiim ar you can vkIl the vkodm Vcpw% mt afHaalrh w 11c (--.vdtL to obtain an decamnic vanirm Qllrl g e O Nanie of foodservice establish t: P;� Name of Owner:T a of Ownership: Individual Corporation Fa ty Address: "ect: �l a Telephone Numbers:( Q Contact Email Address: Plans and Information Submitted B ; o Date: r' Anticipated opening date: Seattng capacity Type of Menu -Please chec-40 k all tha a ly: FullserviceFast Food Gourmet Carryout Caterer School -Public or Private Daycare Group Home Grocery Store Institution_Type Nurdug home Hospital Hotel Continental Breakfast Mobile/push cart Seasonak Type Information to be submitted to Environmental Health Department: Menu Equipment numbered on floor plan drawn to scale Plan review application Pay plan review and annual permit fees Annual permit application nipment apecification sheets and plumbing diagram Type of Water Supply: Fpt3prmovPcd rivate Noncommunity? jY/E Approval Date: Z Type of Sewage System: Public Approved: )YES ONO D Private Approved: O YES ONO Date: Environment Approved by: