HomeMy WebLinkAboutCLE201900158 Application 2020-03-27Ly the Albemarle County
Application for Zoning Clearance cl- 2c't1i-1 5t�`"
CLE # a
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY(Z
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# < Date:
Receipt # Staff: 1�`G
PARCEL INFORMATION
Tax Map and Parcel: 4 5 RI-CcExisting Zoning W
Parcel Owner: 4e_ roa.r U,& L Le-1
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Parcel Address: (%1� ( f\C> City G V < < State 4��
Zi p2Z`� o
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? &rl)T—A Lop_S
Address : S f Loe) u-t q t AQF City State VA —
Zip 2Z 9
Office Phone: (-qff ( (0 3 LCell # Fax # E-mail
APPLICANT INFORMATION
%_iiecit anv Lna[ annly: c .nnnap nt nwnprchin Uhonno nf'.. d_L_..I
Business Name/Type: E—L
Previous Business on this site —LA
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: MF y,-x cA tiJ Fo&7 t F4 Ly fZ� F._S.3,
*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.
Signature �5,%1 ;F :E2/fL S Printed Si&A -75/ /—ts-
AVROVAL INFORMATION
[tj Approved as proposed [ ] 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: '2-000
Building Official Date
Zoning Official Date Z L,
Other Official�n�y Date
r,lovr F CAN
S � J r.,-c..
..uunly ui Hluemane uepartment or v,ommumty Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
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Revised 11/1/2015 Page 2 of 3
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Intake to complete the following:
Y/N
Is I, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
'Y } N
dill 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 wat
If private well, provide Hea rtment 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 p lic 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: d
DN
ittedas: eg4(ky te
Under Section: 2 G(r 2, 1 ( 3 D
Supplementary regulations section:
[3 _
Parking formula:
Required spaces:
_6c� SdaGel 1�V'b�►
Y/N
Items to be verified in the field:
Inspector : Date:
J
Notes:
iolations:
/ N
so, List:
z U1 b �I _'i
Proffers:
Y /�
If Est:
Variance:
Y/N
If sa, List:
/ ,tev' ('eel
✓s r �c� ` to
SP's-
Y/
If so, ist:
Clearances:
SDP's 2 DAD
20o6--iLf%, 24o5
Revised 11/1/2015 Page 3 of3
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,
[County application name and number]
was provided to
[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 to the following address:
Date
[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].
'ty4r1-`� �� f
Signature of Applicant
`_;� lfrfl+— "T - l Wit• r=.;_
Print Applicant Name
7h7 III
Date
COMMONWEALTH OF l,IRGINIA
G'IR GINIA DEPAR TMENT OF HEAL TH
In accordance with the regulations of the Board of Health of the
Commonwealth of Virginia this certifies that
Habanero LLC
is hereby granted a permiUlicense by the Albemarle County Health Department to operate a
Full Service Restaurant
Trading as:
EL HABANERO
Located at:
2291 Seminole Lane
Charlottesville, VA, 22901
Mailing Address:
2291 Seminole Lane,
Charlottesville, VA, 22901
Conditions of Permit (if applicable);
Date of Expiration
July 31, 2020
{
�fic S. Myers, REKS
Enviro mental Health Supervisor
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
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