HomeMy WebLinkAboutCLE201800110 Approval - County 2019-09-05APPROVED
N the Aih nnrin l a r, ,. il.,
Application f" ' '761figft' ' Clearance
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CLE #l l O
PLEASE REVIE"' ALL 3 SHEETS
OFFICE USE ONLY
Check# M Date: `j • j$
Receipt # j [ �CG(D Staff:
PARCEL INFORMATION
Tax Map and Parcel:1� -- Existing Zoning PD-MC
Parcel Owner: 5th Street Station Ventures, LLC
Parcel Address: 355 Merchant Walk Square Citv Charlottesville State VA Zip 22902
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Dan Tucker
Address : 5 SW Broad Street, Suite B City Fairburn State GA Zip 30213
Office Phone: ( 770) 692-8300 Cell # (434)245-4909 Fax # (770)692-8302 E-mail danCg)sjcollinsent.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Basil Mediterranean Restaurant/Assembly A-2
Previous Business on this site New tenant - Unoccupied Suite
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 is a 2,595SE restaurant on Bldg 1300 ---
*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 t 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. f have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
APPROVAL INFORMATION
( tl,Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] B�flow prevention device and/or current test data needed for this site. Contact ACSA, 977-45 1I, x 117.
[ o 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 _ t' Date
Other Official Date
v uunry Ql ,vmemarie uepartment or 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 . �/
Is use m LI, HI or PDIP zoning? If so, give applicant a Certified
£%�ineer's Report (CER) packet.
VN
ill there be food preparation?
If so, give applicant a Health Departmen form.
Zoning review can not begin ntil we re i approval from Health I Supplementary regulations section:
Dept. FAX DATE _ M t� I
Reviewer to complete the following:
Square footage of Use: �;') 0�� �
Circle the one that applies
Is parcel on private well or puc wa ?
'
If private well, provide Health ment 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 ub c se ?
Y/N
Will'Wu be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit # I
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Pin/ni ted as: L l( M t—
��.Under Section: I � In � . � , 1 51 C C
Parking formula: `1
Required spaces:
In_I a
N
ns to be verified in the field:
Violations:
Y/N
If so, List:
r ffers:
Y N
so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances: n� �n f r�(J,0
kql
SDP's
Y
Revised 11/1/2015 Page 3 of 3
COMMONWEALTH of V:tRGitN A
In Cooperation with the
Stale Department of Health
Phone (434) 972-6219
Fax (434) 972.4310
Mr. Raif Antar
109 141" St NW
Charlottesville, VA 22903
Thomas Jefferson Health District
1138 Rose Hill Drive
P. O. Box 7546
Charlottesville, Virginia 22906
AL8EMARLE- CHARLOTTESVILLE
FLUVANNA COUNTY (PALMYRA)
GREENE COUNTY (STANAROSVILLE)
LOUISACOIINIY (I.(X)ISA)
NELSON COUNTY (LOVINCTON)
May 30, 2018
RE: Plan review for Basil Mediterranean Bistro at 355 Merchant Walk Square Building 1300 Suite 300
Charlottesville, VA 22902
Mr. Antar,
Thank you for your plan review submission regarding the proposed food establishment. The plans
provided have been reviewed and approved. No changes to the menu, layout, or equipment must be
made without health department approval. Given the distance between the water heater and the
kitchen, should the water heater you selected not be sufficient to supply the required water
temperatures to the dishwashers, hand sinks, and three compartment sinks another water heater or
booster heaters will be required. Please contact me a week before you would like to pre -opening
inspection to take place. At the time of the pre -opening inspection your food permit will be issued. The
facility must be fully operational at the time of inspection: plumbing, refrigeration, etc. Should you have
any concerns or questions please contact me at the number below. Thank you.
Sincerely,
` J -
Casandra A. Styles
Environmental Health Specialist Senior
(434)-972-6261