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Home My WebLink AboutCLE201200131 Legacy Document 2012-10-24n Application for Zoning Clearance CLE # # is OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # Date: ` Receipt # Staff: , PARCEL INFORMATION Tax Map and Parcel: 04ol \f4 4 �?J" ( - �� E� Existing Zonin� t? Parcel Owner: �' 2leA Parcel Address:Sl tE:z' & 4=®1.)�16Lt> Cit}C<". - U1lL'$_State \& Zip %�:(Z� (include suite or floor) PRIMARY CONTACT � Who should we tail /write concerning this project? --'-T_�e�0 0-- kw'go Address:1rn', )> A'?62YL, -1 IU _r QAU�-,Pty 1 c1G.lat7 State (� Zip , Office Phone: LOA 741, Cell # Fax 4104 • f ° KL** -mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name 6 New business Business Name /Type: TV -41,V i i1Jd f A yc�' : i&ao Previous Business on this site 10 ! l 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: mL ''mi2. *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 o or have the wne"s perm sion to use the space indicated on this application. I also certify that the information provided is true and accurate to the st of n wl dge. I I ve read the conditions of approval, and I understand them, and that I will abide by them. 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, 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 / Zoning Official "w Date 11 Other Official _ /J Date 117—V /2-61 County of Albemarle Department of community iuevetopmeni 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 r� Intake to complete the following: Y Is On LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y'/ N ill 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 7o)15�' Circle the one that applies Is parcel on private well o ublic water If private well, provide Health epartment form, Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic ublic sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N ill there be any new construction or renovations? If so, o he per e it „ Permit # 7—i"m fn nmmnla+a +ha fnllnwina- Reviewer to complete the following: Square footage of Use: </A ') / N ermitted as; it Under Section: �i p�i�Y C• yl� Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Viola y/ If so, ist: offers: V1 N so, List: ZJI� y �d In— 3 Variance: Y/N If so, List: SP`s: Y /.N If so, List: Clearances: SDP's - 45 —/22 67 — <O Revised 7/1/2011 Page 3 of 3 i 07/23/2012 23:25 9724310 am.as efferson 9vrvrn9: AlbrMer1a Charlooc -01c HEALTH DISTRIoT Fruvo+tnr arcono 1.owsa Nolcan Foodservice Facility Plan Review Evaluation 1#5489 P.001/001 Charl oiterville/Albernorle 138 Rose Hill Drive Charlorresville, YA 22943 P, 0, )3ox 7S46 Chorlottesville, YX 22906 Phone: (434) 972 -6259 Fox: (434) 972 -6221 Should I contact the Health Department whet, opening a new establishment or when selling or transferring ownership of my restaurant? Tho Hcalth 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 Ylrglnla Food Regularions 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 epthority allowing tbom 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. Flow 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 anew 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 Regulailons are frequently being updated. When a restaurant undergoes a cbanga of ownership, the facility is then treated as a brand acw cscablishmcnt Subsequently, the facility must first meet substantial compliance with the most current version oftho Virginia Food Regulations before a permit can be issued (see the previous question). Now can I obtain a copy of the current version of the F` r; irzla Food Regulctiont? A limited number of copies are available for purchase at your local health department office, or you can visit the Virginia Department of Health websitc (www.vdh.virginia.gov) to obtain an cloctonic vtrsioa- Name of foodservice establishment: Name of Owner: Address: Telephone Numbers.-( Contact Email Address: Building permit # Plans and Information Submitted By; Anticipated opening date: Type of Menu - Please check all that apply: �ug capacity Past Food Gourmet Carryout Caterer School--Public or Private—Dayeare_Group Home Store lnstitutioi _Type Nursing homer Hospital Hotel Continental Breakfast Mobile /push cart Seasonal Type Information to be submitted to Environmental Health Department: Menu Equipment numbered on floor plan dravm to scale Plan review application Annual permit application Type of Water Supply: Type of Sewage System: Environment Approved by: Pay plan review and annual permit fees Equipment specification sheets and plumbing diagram Private Noncommunity7 YES NO Approval Date: Approved: YES ❑ Private Approved: ❑ YES al Healt proval/Denia Date: ■i• ❑ NO Date: