HomeMy WebLinkAboutCLE201100072 Review Comments Zoning ClearanceApplication for Zoning Clearance
CLE # Ziiil -7 2i
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE QNLY ////
Checic # i5 /° Date: ` , /i/'J/
Receipt # 5 z ti Staff; JoUff
PARCEL INFORMATION j / q
Tax Map and Parcel: �UC Existing Zoning
Parcel Owner: li' Aip1mr)&v
Parcel Address: l<7 (� J! 7 /�ity�`D State � 4 1//'zip
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project? ` 0"r-y-, !'l 1A)
Address; 16 hrl CFLIX'1+tf_L r-, 1 tA,4_) City State . Zip a �'
Office Phone; ( —) Cell # .4 (PS (vZirFax # E -mail +-LiIh i h
APPLICANT INFORMATION
Check any that apply: Change of ownership of use Change of name 1.--New business
JChange
Business Name /Type: 1 1 A.: 1
Previous Business on this site ��� v � •--�
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 knoi-dedge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed wa )4
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 ofcompliance 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 Date
.. a
(County of Albemarle Department of C'@.mmunity Developnfent
401 Mclnt e 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:
Y /
Is u • LI, I-Il or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
I there be food preparation?
I f so, give applicant a Health Department form.
Zoning review can not be in until we receive approval from Health
Dept. PAX DATE W
Circle the one that applies 3
Is parcel on private well public water.
If private well, provide I1 ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies--- ---- -7
Is parcel on septic r public se
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followinL-:
Reviewer to complete the following:
Square footage of Use: 11560
Y rmitted as: 1% . ej O6
Under Section:
Supplementary regulations section;
Parking formula:
Required spaces:
V /IN
Violations:
Y/N
If so, List:
Pro e •
Y N
If so, List:
Var'
Y N
If so, ist;
SP' Q
Y /
If s:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of 3
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TEL No. 434 - 465 -7626 Commonwealth of Virginia CL:
Food Safety and Security Program REG FU:
CFN: new firm Department of Agriculture and Consumer Services NEXT IN,
FEL 3 - -- Albemarle P.O. Box 1163 BY: RAO
Richmond. Virginia 23218
INSPECTION REPORT
TO: Tammy Whiting Owner May 3, 2011
(Owner or Operator (Title) (Date)
Junior's Deli 667 Country Green Road, Charlottesville Virginia 22902
(Firm Name) (Street Address) (City) (State) (Zip Code)
During an inspection of your deli
the following objectionable conditions were observed:
on May 3, 2011
A particle wooden board; not easily cleanable was observed screwed down on top of the grill in the deli.
2. A gap in the counter top; not easily cleanable was observed in the deli.
A plastic round stand with holes that would accumulate food was found being used as a legg to the grill in the deli.(not easily
3. cleanable.
4. Four unshielded overhead fluorescent lights were observed in the deli.
5. A gap in the ceiling tile above the food prep counter was observed in the deli.
note: mailing address:
70 Mountain View Appartments, Afton, Va. 22920
Ja rte„
left with Tammy Aing owner b
Inspection Report y g Y
Name Title
#*-tl�
R.A. Olinger
Adulterated food items listed in observations were destroyed with my consent.
Witnessed the collecting, marking, or sealing of samples
Inspector # 954
❑ Portion of Sample was left with vendor ❑ Vendor did not desire portion of sample ❑ Pictures Price Paid: $
Rdnts ❑ Insts ❑ Dirty fiq ❑ Dirty Pr. ❑ Misbrnd ❑ Pest Mis ❑ Pat Decl ❑ Inf Form ❑ App Lw ❑ I:gg Lw ❑
Sanit ❑ Tmp I lot
❑ Tnip Cold
❑ krap Prac ❑ Unp Food
❑ Sel Sery Sup ❑ Bldg ® Iiquip
®
Plumb ❑ Adult I;d
❑
Water (public /private): public
Sewer (public /private): public
Name Change ❑ Add Change ❑ Nw Frm ® Food Svc ® 1 II) Inspns ❑ Frr, Des ❑ I lome Op ❑ New Owncr ❑ Wholesale ❑ Retail
INSPECTION TVIIE, BASIS OF INSPEC'T'ION
State ® Contract ❑ Routine ® Compliance ❑ Complaint ❑
Product
FDA It
Actiou Taken
Lbs
P -#
Lot Code
Problem w /Product
SPECIAL CIRCUMSTANCES/CONDITIONS
Audit Inspection ❑
FDA Audil Inspection ❑
Diet Supplements ❑
Disaster /fire ❑
Recall Check ❑
RISK ASSESSMENT
High ❑ Medium ® Low ❑
Product destroyed by management winio T the Inspector's request in the following observation(s):
The above item does not require the signature oj'numagement and is NOT included in the voluntary destruction section of the Inspection Report