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HomeMy WebLinkAboutCLE201900132 Action Letter 2019-07-16Intake to complete the following: Y /.N Is u n LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y N 4iIl 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 Ovate If private well, provide Healt epartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applie Is parcel on septic or ublic sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the followin : Reviewer to complete the following: Square footage of Use: I Erm' N itted as: Q Under Section: 2-2 Z . Supplementary regulations section: Parking formula: cc r / 100o sF Pew-ri c foci-\ Required spaces: Q Y / Items to be verified m the field: N© Inspector : Date: Notes: L_ el1i-C— �c v G i --ee Violations: Y/N If so, List: offers: Y/N so, List: (� Q Variance: / N If so, List: sY OY/, N o, List: V 5� Zol Z[ Clearances: i ` L SDP's�,l� Revised I l/ 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. 1 certify that notice of the application, was provided to [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 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 COMMONWEALTH OF VIRGINL4 VIRGINIA DEPARTMENT OF HEALTH In accordance with the regulations of the Board of Health of the Commonwealth of Virginia this certifies that A Harbour inc. is hereby granted a permit/license by the Albemarle County Health Department to operate a Fast Food Restaurant Trading as: JERSEY MIKES Located at: 2040 Abbey Road Charlottesville, VA, 22911 Mailing Address: 6200 Fort Avenue, Lynchburg, VA, 24502 Conditions of Permit (if applicable); Date of Expiration May 31, 2020 Environmental Health Specialist; Si 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