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Home My WebLink AboutCLE200900005 Legacy Document 2012-08-22Application for Clearance CLE # ti Zoning Clearance = $35 OFFICE USE ONI Y, 0 Check # //- O Date: PLEAREVIEW ALL 3 SHEETS Receipt # Staff: PARCEL INFORMATION ', /,g `7 l /b Z— Existing Zoning_ Tax Map and Parcel: Parcel Owner: __ ,, Parcel Address: v�'1�`"'� City��AI State V� Zip (include suite or floor) PRIMARY CONTACT'` - �� U Who should we call /write concerning this project? Address: i 5— `��'17L1(;ti' City � �!(t�.C.Lv� State VR Zip: ✓�1'� Office Phone:46�6 °I R V Cell 4 Y �ax E -mail APPLICANT INFORMATION Check any that apply:: Change of ownership% Change of use Change of name New business Name /Type: L- JC /�- Business J"°� •.. Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of �Id vehicles, and any additional information that you can provide: t.. / jd�� 4 C7s�✓G+^ *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 thattII will abide by them. ��-''f Signature Printed- 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, x119. [ ] 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 1 3 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 04/28/08 Page 2 of 3 t d ' Intake to complete the following: Is /aIs us an LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. VY,V N 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 u lic water. If private well, provide Heat n form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic u lic sewer?. Y Wi ou be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ; N il1 there be any new construction or renovations? If so, obtain e pro er Permit. Permit # Vll 7.nnina to rmmnlPtP 1-hp fnllnwina- Reviewer to complete the following: Square footage of Use: Y/N Permitted as: Under Section: Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Violations: Y/N If so, List: Proffers: Y/N If so, List: Variance: Y/N If so, List: SP's: Y/N If so, List: Clearances: SDP's Revised 04/28/08 Page 3 of 3 Iomas efferson Serving: Albemarle Charlottesville HEALTH DISTRICT Fluvanna Greene Louisa Nelson Foodservice Facility Plan Review Evaluation Charlottesville /Albenzarle 138 Rose Hill Drive Charlottesville, VA 72903 P. O. Boa 7546 Charlottesville, FA 72906 Phone: (434) 972 -6259 Fax: (434) 972 -6221 Should I contact the Health Department when opening a new establishment or when selling or transferring ownership of my restaurant? The Health Department should be one of the first agencies contacted whenever a change of ownership or construction of a new facility begins. Restaurant permits are non - transferable. The Virginia Food Regulations require that the new owner submit a plan review application for a restaurant permit. Once plans are approved this form will be submitted to the local building authority allowing them to issue your building permit and business license. Furthermore, a plumbing rough -in and an opening inspection is required prior to issuing a permit to the new owner. How soon can I open after I submit a "change of ownership" application? ,The issuance of a new permit may first require substantial facility renovations and upgrades. It is recommended that the owner and prospective buyer submit the paperwork outlined below and then arrange an inspection with the Health Department to assess if there are upgrades to the equipment or facility that will be required prior to issuing a new permit. Why am I (the new owner) being denied a permit, when the previous facility owner had been in business for years? The Virginia Food Regulations are frequently being updated. When a restaurant undergoes a change of ownership, the facility is then treated as a brand new establishment. Subsequently, the facility must first meet substantial compliance with the most current version of the Virginia Food Regulations before a permit can be issued (see the previous question). How can I obtain a copy of the current version of the Virginia Food Regulations? A limited number of copies are available for purchase at your local health department office, or you can visit the Virginia Department of Health website (www.vdh.virginia.gov) to obtain an electronic version. Name of foodservice��estab/�lishment: Name of Owner: L'r��'� Type of Ownership: Individual_ Corporation Facility Address: 511113d 'A0 j\1j Architect: 41�'— Telephone Numbers: (G�'y•) r �� Contact Email Address:'�� —' °'�� ALL Plans and Information Submitted By: Anticipated opening date: Type of Menu - Please check all that apply: Date: Seating capacity Fullservice )4- Fast Food _Gourmet Carryout. Caterer School--Public_ or Private_Daycare_Group Home Grocery Store—Institution Type Nursing home_ Hospital_ Hotel Continental Breakfast_ Mobile /push cart Seasonal--Type Information to be submitted to Environmental Health Department: Menu V11, Equipment numbered on floor plan drawn to scale Vo" Plan review application V"' Pay plan review and annual permit fees Annual permit application v,**' Equipment specification sheets and plumbing diagram Type of Water Supply: ublic r Private Noncommunity? Y �ES NO Approved Type of Sewage System: V`l'ublic ❑ Private Environmental Health Approval/Denial: Approved by: Approval Date: Approved: p,ff—YES Approved: ❑ YES Date: ❑ NO ❑ NO Date: