HomeMy WebLinkAboutCLE201100038 Review Comments Zoning Clearance 2011-02-28pplication for ZonNLY Clearance
CAE # 1
- PLEASE REVIEW ALL 3 SI C+ ETS
OFFICE USE ONLY
cheek ][late;
Receipt # ��tnff: �
r •rte.-E IFOR min ,p J
t'.Fi,Ft�,d,z aI' a +vxcl`t<` ��vi d
Tax Map Parcel: x/54 U c��`i� -C '`s" � Existing Zoning
and
Parcel Owner:
ParcelAcldress;
(include suite or floor)
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PRIMARY CONTACT
Who should we call /write concerning this proj cot? �.
State Zip
Office Phone: � - S59' Cell # Fax # 'a5 oil t E -mail
APPLICANT INT' Q49ATION
Cheek an that a ply: Chan a of ownership Change of use Change of name New business
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Business NamelType: 1046 ,,-
Previous Business on this site L ` 9` ,
Describe the prop osed business including use, number of employees, numb, ekof shifts, available parking spaces, number of
vohieles, and any additional inforntntion that you can Provide: Lj
*This Clearance will only be valid on the parcel for which it is approved. If you change, inlensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I olyp or have the owner's permission to use the Pace indicated on this application. I also certify that the information provided
is true and accura t �t 6 bit f m o e, I have re conditions of approval, and I understand them, and (lint I will abide by thew.
Signature tJ/ Printed t U
APPROVAL INFORMATION
Approved as proposed [ J Approved with conditions j j Denied
[ ] Backfiow 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.
j' ] This site complies with the site plait as of this date.
Notes:
Building Official Date 3
r(1
Zoning Official r .l , Date
Other Official
County of Albemarle Department of e:on►murnq .vevelopment
401 McIntire Road Charlottesville, VA.22902 Voice: (434)296 -5832 Fax: (434) 972 -4126
Revised 1/1 /2011 Page 2 of 3
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Intake to complete the following:
_
Reviewer to complete the following:
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Y A N
Square footage of Use:
Is u m i,I, Hi or PDIP zoning? If so, give applicant a Certifled
Report
h' / N
Engineer's (CER) packet, „ ,
Permitted as:
Y N y
SP's:
Y
If , ist:
"Will there be food preparation ?. -- -.
Under Section:-
If so, give applicant a Health Department form:
Zoning review can not egi until we receive approval froin Health
Supplementary regulations section:
Dept, FAX DATE l
Clearances; __
Circle the one that applies
Is parcel on private well g� public watO
Parking formula:
If private well, provide He`aTt epartment form.
Zoning review can not begin until we receive approval from Health
Required spaces:
Dept. FAX DATE w
Y/N
Circle the one that applies
Items to be verified in the field:
Is parcel on septic r u, llc sewer
Y /D
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Inspector: Date:
Notes;
U t ye be, any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Violations: _ - - _ _ --
/N
so, List:
proffers:
If so; List:
Variance:
Y /�
If s ist;
I ,
SP's:
Y
If , ist:
Clearances; __
SDP's
Revised 1/1/2011 Page 3 of
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COM ONWE ALTH OF VMrMA
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DEPARTACi NT OF 119ALTH
M?27FIES THAT
~ • r Ot'ant Avenue D6vel men#
is hereby grunted a permiNicense to operate a Fast Food Restaurant
by the Albemarle County Hea7th Department in accordance
with the regulations of the Board of R'ealth;
Commonwealth of Virginia.
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FA CIL I TYNAME: ARBY S i
PHYSICAL ADDRESS: 1700. r1mberwodd Boulevard
Charlottesville, Virginia 22911 �
AWL&OADD"SS., 1740 Timberwflod Boulevard
Charlottesville, Virginia. 22911
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E)PIRATION DATE: DeOe>p Or 3 7s Z 7' 7
CONDMONS:
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Kenneth E, Stutz, MPH, REHS �-
'EnWronmental HeaYth specialist, $0nicir
.Please direct questions or concerns to the
Albemarle County Health Department,
.environmental Health Services, (434).97-2-6-719.
This Permit Is NOT TRANSFERABLE From One Individual
orLocatlon to Another.
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