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Home My WebLink AboutCLE200900038 Legacy Document 2012-08-27Application for Zonin Clearance ,2 is �oning Clearance = $35 OFFICE USE ONLY Check # Date: 'I PLEASE REVIEW ALL 3 SHEETS Receipt # Staff: PARCEL INFORMATION 00 (� n Tax Map and Parcel: � ^ — — — 0 / / �7 471►sting Zoning {C. f Parcel Owner: \,t- �4 �Q TC Parcel Address: o qL �cf �i1 �1A i1 I(� �fc. �\ City C5 State Zip c i , (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project ? obu 4 1 /Gila S / Address : a5� 1-Cc ,.� 5 �� c� City �lCkSl! S 1 State V k} Zip �k�3 Office Phone: Cell # " Fax # E -mail I i� APPLICANT INFORMATION Check any that apply:, Change of ownership Change of use Change of name New business Business Name /Type: �U„ t i ct KSL T " c my\ IwC p Previous Business on this site CC>n \,4,Ace CKQ_ Describe the proposed business including use, number of employees, number of shifts, available parkin spaces, number of v hicles, and any additional information that you can provide: 11t 9J �� kit rr _ 3c) ackme L = u-p 1, *T i s 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 e best of y knowled ve read the conditions of approval, and I understand them, and that I will abide by them. --��5 � c, S Signature Printed � eQ 1 APPROVAL INFORMATI N ;XApproved as proposed [ ] Approved with conditions [ ] Denied [ ] Bacicflow 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 Zoning Official Date��'� y Other Official Date C, 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 :j ° _i110I11.aS efferson HEALTtt DISTRICT CLE 20v i 3S�` Serving: Albemarle Charlottesville Fluvanna Greene Louisa Nelson Foodservice Facility Plan Review Evaluation Charlottesville /Al benrarl e 138 Rose Hill Drive Charlottesville, VA 22903 P. O. Box 7546 Charlottesville, VA 22906 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 establishment: Name of Owner: Facility Address: A tact l Telephone Numbers: (Q1 I Type of Ownedship: individual � � Corporation. Architect: (k,2<1) x-13 - 3-13 Contact Email Address: 'i1 t4 Plans and Information Submitted By: v\�, H n C c; ` Date: Anticipated opening date: Seating capacitXGo;;et check all that apply: Fullservice Fast Food Carryout Caterer Type of Menu - Please h — School— Public or Private _D aycare —Group Home — Grocery Store_ nstitution_Type Nursing home_ Hospital_ Hotel Continental Breakfast_ Mobile /push cart — Seasonal_Type Information to be submit Menu Plan review application Annual permit application Type of Water Supply: ted to Environmental Health Department: Equipment numbered on floor plan drawn to scale Pay plan review and annual permit fees Equi ment specification sheets and plumbing diagram Public o Private Noncommunity? OYES NO Approved Approval Date: Type of Sewage System: ❑ Public rivate Environmental Health Approval/Denial: Approved: Approved: ❑ YES ES Approved by: Date: ❑ NO ❑ NO Date: + U r+ 7 Intake to complete the following: Reviewer to complete the following: Y / N Square footage of Use: DO Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. �� / N Ormitted as: there be food preparation? V ill N Under Section: 4A n1 G,), (&-,4,, (y , ' r z If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Supplementary regulations section: Circle the one that applies Parking formula: Is parcel on private well or public water? If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE Y/ tq Circle the one that applies Item be verified in the field: Is parcel on septic or public sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Inspector : Date: Y / (P Notes: Will t sere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Violations: Y /0 If so, t: Prof rs: Y If so, ist: Variai ce: YO If so, List: SP's: Y /A If so, ist: Clearances: p SDP's Revised 04/28/08 Page 3 of 3