HomeMy WebLinkAboutCLE201100190 Review Comments Zoning Clearance 2011-11-08Application for Zoni1nT Clearance
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OFFICE USE ONLY
Date: ' )�
PLEASE REVIEW ALL 3 SHEETS
Check #
Receipt # 0046 ;Ug Staff:
PARCEL INFORMATION
` —"" Z G Existing Zoning
Tax Map and Parcel: 6
Parcel Owner: � ra4f- %4
Parcel Address: �� z %'L i�+ c�1M�NcX City State Zip
(include suite or floor)
PRIMARY CONTACT ``,�
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Who shoulffd,, we call /write concerning this project? r� c�c�
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Address : `i��Z. 'l c� o.. �� City �` 5 wo (IC State V A Zip TZ
Office Phone: L_) Cell #'1 *5 -o 16 Fax # E -mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name /Type: 15 0:% To.�ter Mark�� LL C.
Previous Business on this site
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: 'Sct.V.s g Q c Q�lc cLw S �v , c QCs
*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.
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Signature Printed �. t�d� r' � Q Q, ("LS
APPROVAL INFORMATION
j 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:
Building Official Date l (! 1
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Is/iV/
Is u �m LI, HI or PDTP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
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l 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 a Realth s
Is parcel on vate or public water?
If private we rpro Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel o�Ti or public sewer?
Y /'i ,�/
Will y��(('be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
YWi/
ll ere 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:
mitted as:
Under Section: 16. 2 .
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Items to be verified in the field:
Inspector :
Notes:
Date:
Violations:
If so', -List:
Prof
Ifs Mist:
Variance:
Y/A
If so, ist:
SP's:
/t /N
` f so, List:
Z -5`1p, 3
;7 c- - v
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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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, / , c l r o ()/- 70(\kA.0 02 0 Q,.j (, .,_
[dinty application m1me and number
was provided to Pt -rro t 5k �' G /W' 1(,A A- 4, C a the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number Z �`' ��` "`°'�� �q by delivering a copy of the application in the
manner identified below: oo I
Hand delivering a copy of the application to C ��'� ' '1 L
[Name of the record owner if the record owne 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].
Signature of Applicant
sgrr ( -o, ),l. -1RA rk-s
Print Applicant Name
Date
TEL NO. 434 -882 -0244 Commonwealth of Virginia CL:
A Food Safety and Security Program REC Fu:
CFN: new firm Department of Agriculture and Consumer Services NEXT IN:
FEI: 3 -- Albemarle P.O. Box 1163 BY: RAO
Richmond. Virlinia 23218
INSPECTION REPORT
TO: Sandra B. Melgares Owner November 4, 2011
(Owner or Operator (Title) (Date)
Boyd Tavern Market 4842 Richmond Road, Keswick Virginia 22947
(Firm Name) (Street Address) (City) (State) (Zip Code)
During an inspection of your grocery & deli on
the following objectionable conditions were observed:
Pre - Opening Inspection:
No objectionable conditions were observed during today's inspection.
NOTE: The Corporation name is:
Boyd Tavern Market t 4. C_
4842 Richmond Road, Keswick, Va. 22947
November 4.201.1
�J)Y— �A6- -d'1-79
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Inspection Report left with Sandra Melgares owner by Allyn Olinger
Name Title
Adulterated food items listed in observations were destroyed with my consent.
Witnessed the collecting, marking, or sealing of samples
❑ Portion of Sample was left with vendor ❑ Vendor did not desire portion of sample ❑ Pictures
Inspector # 954
Price Paid: $
11 -11 -04 new firm Inspection Report.doc Page 1 of 2 Received bv: