HomeMy WebLinkAboutCLE201900226 Action Letter 2019-09-26Application for Zoning Clearance It Loll- 2
CLE #_
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OFFICE USE ONLY Z Y
PLEASE REVIEW ALL 3 SHEETS Check# i L Date:
Receipt # d Staff: /`.t/t/
PARCEL INFOR
Tax Map and Parcel:
Parcel Owner: Ll, ,, /'. /. t"'/p /T o
Parcel Address: t 6l(1-:�) '4v_TYAW66' �"City
(include suite or floor)
G Existing Zoning IA*2t(l f C-
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U-4
Zip 2,40 (
PRIMARY CONTACT
Who should we call/write concerning this project? ca_q I �Q
Address : `� 2, `J ��Rt� _)kCY\ 0 City Q( Vll `$fate Zip 74;
Office Phone: t 119 Cell # E-mail C(�� (C� W Pksi �c C
APPLICANT INFORMATION
Check any that apply: Change of ownership pp Change of use ``Change of !name New business
Business Name/Type: naO& C-3max., /*Y -zM10,-)
Previous Business on this site c'5 a Lu h 1L !✓
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 y knowledge. I have read the conditions of approval, and I understand them. and that 1 will abide by them.
Signature pri„tM
APP"VAL INFORMATION
[ pproved as proposed [ J Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, x 117.
[ J No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ J This site complies with the site plan as of this date.
Notes:
Building Official Date
Zoning Official Date
Other Official
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised I1/1/2015 Page 2 of
Intake to complete the following:
Y
Is LI, HI or PDfP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
/ N
ill 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 p is Ovate 9
If private well, provide Hea ment 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 blic se
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:
N
ermitted as: 4/ 7�e�O`` � '� Lif-4 !
Under Section: ,14 Z yct 2t ( lam✓ lkc-
Supplementary regulations section:
Parking formula: 114Oo 0 z-
Required spaces: Ve
1+f�
�e P—
YIN
Items to be verified in the field:
Viola ' ns:
YI�
Proff s:
Y/
If so, ist:
7✓l� 2.01 (-2Z 2 0
If so, lst:
t? — d /Zoo{ —105
14 2y 7:-;5
Va �e:
Y
Sp's
Ifs E
I f 1st:
l"'
I f:
Clearances:
r
SDP's
Revised 11/1/2015 Page 3 of
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
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number _
manner identified below:
V 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].
Signatu o icant
Print Applicant Name
Date
COMMONWEALTH OF VIRGINIA
V1RG1N1A DEPARTMENT OF HEAL TH
In accordance with the regulations of the Board of Health of the
Commonwealth of Virginia this certifies that
Ronald Omar Ardon Bonilla, LLC
is hereby granted a permit/license by the Albemarle County Health Department tc operate a
Full Service Restaurant
Trading as:
SAM`S KITCHEN
Located at:
1863 Seminole Trail
Charlottesville, VA, 22901
Mailing Address:
1430 Forest Spring,
Earlysville, VA, 22901
Conditions of Permit (if applicable);
Date of Expiration
amber 31,2019
Lauren OglenV
Environmental Health Speclallst Sr.
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