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Home My WebLink AboutCLE201200115 Legacy Document 2012-10-230 E!l I ME Applicatio n for Zoning 06r OFFIC" use i g'Y PLEASE RIDI VVIE'W ALL 3 SHEETS Check # Date: Receipt # �� Staff: PARCEL INFORT�T /-9-71 q Map Parcel; ��J ' Existing Zoning Tax and Parcel Owner; A IbefilAV-!t% FIX?— 4 in ft� �/+ Parcel Address: 3 "1•- $y/�oL.t�CTU'll City Chmt(t fur *State V/� ZipZ�Yo (include suite or floor) PA'S' CONTACT � Who should we calllsvtriite concerning this project? cilal�S LAildt% Gpxm- e, + AVM( o t Address: '72to isco4-wAyig �10- City tei'9E30A State Mp n4p 1 Office Phone: ('��I) 34*'- S19 ell # eA- +' 1 ax # 361.65244 -mail ChAilig ed SAr AUMY¢: �- 7j 3? APPLICANT INFORMATION oJf�use� Change of name New business Check any that apply; Change of ownee�rship/t (� rChange r Business Name/Type: �1ti2� S t%! �Lt�i [ bT - yl��Tl� p� `�� I LLC Previous Business on this site ice• F( Describe the proposed business including use, number of employees, number of shifts, available arking spaces, number of vehicles, and any additional information that you can provide: $60 r'A t Ur7 (4 AI?t M e w t� *This Clearance will only be valid on the parcel for which it is approved. Ifyou change, Intenslt , or move the use to a new location, a new Zoning Clearance wit( 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. Signature T�* dzpM -' Printed T!�?�t, 60/pw APPROVAL INFORMATION -X Approved as proposed j ]"Approved with conditions [ ] Denied [ ] Backffow 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 compiles with the site plan as of this date, Notes: Building Official '" �-- -a-� —L bate Zoning Official Date f Other Official Date ✓ ( County of Albemar16 Departmeht of Cbm nity Dnveloprhent 401 McIntire Road Charlottesville, VA 22902 Voice: 34) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 LiM Intake to complete the following: YIN Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet, YIN Will there be food preparation? If so, give applicant a Health Department form. Zoning review can not be in u til the receive approval from Health Dept. FAX DATE G( v Circle the one that applies Is parcel on private well �P=gent If private well, provide He form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or �b11"'�'x? YIN Will you be putting up a new sign of any kind? If so, obtain proper Sign permit, Permit # YIN Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # �Z-UI2 93 7 I} f/ 7nnino to emmnlete the fallowinLy: Reviewer to complete the following: Square footage of Use; ; IN Permitted as e- 1 iIl Under Section: _4�" Supplementary regulations section: Parkin formula: Parking Jam/ Oc� Required spaces: Y /(N) Items o be verified in the field: Inspector : Date: Notes: Violations: if If coffers: / N Iffso, List: �ir�g �Gl vac ce: Y/ If so, ist: Y /IP If so, List: Clearances: SDP's 07 —26 .(u4 Revised 711/2011 Page 3 o£3 i r O A M Ill moo I*w �g8�� o :77 - Mi to Rt Kii MW m I II 0 lo O cr- L=11 - - - �b.ox».as efferson Serving: Albemarle Charlottesville HEALTH DISTRICT Fiuvanna Greene Loulsa Nelson Foodservice Facility Plan Review Evaluation Charlottesville /Albemarle. 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 Firginia 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. Building Permit # Name of foodservice establishment: 0IL�b tj 5 CT2i l Cg4" VT- 67SJ/'(I Name of Owner: �rr�rianS C-mlj � L_LC Type of Ownership: Individual_ Corporation Facility Address: 5 lion AT' sm-is e(d Architect: - oh,.i SA r-+E�-- 19-1- . Sq 2-1 4 LI) LZ-6- N. w Y Telephone Numbers:(1,7g) Gl.14- 55ZP (709) S-31 — b %yam Contact Email Address: [x, 6rdoA6® bur4- rMSG0_i ( I - C-o ti Plans and Information Submitted By: e-FCL 1t-CY, &04,0_0 J Date: e. ! It 7y I Z-- Anticipated opening date: �2L�> tb.2L. Zo 12, Seating capacity 22 Z Type of Menu- Please check all that apply: Fullservice �t Food Gourmet Carryout School - Public or Private Daycare _Group Home Grocery Store Caterer Institution Type Nursing home_Hospital_Hotel Continental Breakfast Mobile /push cart Seasonal Type, Information to be submitted to Environmental Health Department: Menu. Equipment numbered on floor plan drawn to scale Plan review application Pay plan review and annual permit fees Annual permit application Equipment specification sheets and plumbing diagram Type of Water Supply: 69;) r Private Noncommunity? YES NO Approved Approval Date: Type of Sewage System: rfublic Approved: ❑ YES ❑ NO ❑ Private Approved: ❑ YES ❑ NO Date: Environmental Health Approval/D Approved by: ��ll /� U l < L —r�l Date: ' ✓ �_