HomeMy WebLinkAboutCLE201900116 Action Letter 2019-07-29Application for Zoning Clearance
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CLE # %G'l?L�'L' (lam_
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY _
C4*1S /, Date: 5 .�
Receipt # // f ,2.G) Staff: ("z,L -
PARCEL INFORMAT} ON
Tax Map and Parcel: C�4 /L7G7 -,O0 - _r e0 U Existing Zoning ,"��%►,,:,�, e_- _
ParcelOwner•,
Parcel Address: / 5 ,2 1Z W . City rl Zip
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(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? �%/� •/� may,��G
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Address : t S zz ��1 RY�CT City 4( S ate Zip
Office Phone: Cell # _ � Fax # E-mail C
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type:
Previous Business
on this site —
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:
*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 1 understand them, and that I will abide by them.
Signature Printed
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, 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
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Zoning Official / — Date 7 �Z� Z�
Other Official Date
t:ounty 01 Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised I 1 / ] /2015 Page 2 of 3
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Intake to complete the following:
Y/N
Is LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / No
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 or public water?
If private well, provide He emit ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic public 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 following:
Reviewer to complete the following:
Square footage of Use: S'
N
iitted as:(Z CS (a�(�Sl�r��rS feSfGu,ra�
Under Section: 25 • Z • i --� 24• Z
Supplementary regulations section: A/ W
one
Parking formula:
PP( SRP
Required spaces:
SS SQaCCS C�c�t) �F
Y /
Item o be verified in the field•
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Inspector:
Notes:
Date:
Viola,A'ons:
Y d�-1 ITS ist: +
Proff s
If sd; 1st:
AJo-w-
Var,0fe:
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If so, List: ln n� C�
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(Y/,N
�f''so, List:
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Clearances:
SDP's
S n Q 0000 125, �Vsk;C7
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 Me
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]
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 VIRGINIA
VIRGINIA DEPARTMENT OF HEALTH
In accordance with the regulations of the Board of Health of the
Commonwealth of Virginia this certifies that
H and A New River Inc
is hereby granted a permit/license by the Albemarle County Health Department to operate a
Fast Food Restaurant
Trading as:
NEW RIVER COFFEE
Located at:
1600 Rio Road East
Charlottesville, VA, 22901
Mailing Address:
275 Tall Oak Boulevard,
Christiansburg, VA, 24073
Conditions of Permit (if applicable);
Date of Expiration
July 31, 2020
Archer Campbell, REH9
ental Health Technical Specialist
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