HomeMy WebLinkAboutCLE201300104 Legacy Document 2013-05-20A ;* l om
App lie
fr I
G ' U Cl t• ~ �r
orrlc>J ors � Y
PLEASE REVIEW ALL 3 SHEETS Check # �V� Date:
Receipt /I _- 1 ` staff:
PARCEL INFORMATION
Tax iffap andFueel: .Existing Zoning d(lhtv6Ly/ 'f C.rd2J
Parcel Owner:
Parcel Address: 3yy0 t �tid�i Trr� I X16( city Of - ;lk state_ VA zip�11
(include suite or fluor)
PRIMARY CONTACT
Wlio should rve call /write concerning this project? 0-61 13�cme h
Address: 321 e!215-�-hr66LTt— city Cyme7wsd(1 /e state V14- zip '9I
Office Phone: C-Y�5 Cell # Fax # r -nnail /1 �`�/j8$f�G`Q %1�lCSGf�S
APPLICANT INFORMATION
Check any that apply: Change of ownership Ch /tinge of use Change of name Ne)v business
Business Name/Type: KkWCt� S �. S uA,5 l 'DEL
Previous Business on this site—
Describe the proposed business including use, number of employees, number or shifts, available parking spaces, number of
vehicles, and any additional information that yo can pr vide:
*This Clearance will only be valid on the parcel for which It Is approved. Ifyou change, intensify or trove the use to a new location, a new 'Zoning
Clearance will be required.
I hereby certify that I own or have the owner's pennission to use the space indicated on this application. I also certify that the infomtation provided
is true, and acaurate tp t -best of m knowledge. I have read the conditions ofapproval, and I understand them, and #hat I will abide by thetn.
Signature
APPROVAL INrORMATION
'Approved as proposed [ 1 Approved with conditions [ ] Denied
j Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ J No physical site inspection has been done for this clearance. Therefore, it is not a deierinination of compliance with the existing
site plan.
[ ]This site complies with the site plan as of this date,
Notes:
Building Official ':Z--\,�,A,AJkl-A
j nom^ Date _ �� (_ y (l;;i
Zoning Official Date _ �Zb/�L -J[�
Other Official />'�ffs' Y�� Date
t+
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 'Voice: (434) 296.5832 Fax: (434).972-4126
Revised 7/1/20.11 Page 2 of 3
w
I
Intake to complete the following:
Is/
Is use-' LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
YXN
ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can n be in u it w recei e approval from Health
Dept. FAX DATE "JCJ�J I
Circle the one that applies
Is parcel on private well o public water?
If private well, provide Hea Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o p�`ublic sewer.
Y /
Will u be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the rop r Perm n
Permit # ��/
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: 15b3
�flermitted as:
Under Section: 0 Ly. 1
Supplementary regulations section:
Parking formula: l3
Required spaces:
Y/6)
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y /(N)/
If so, ist:
Proffers:
N
I so, List:
Variance:
rY)l
so, List:
% b J
SP's:
/N
so, List: _
Uh L
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
: ,
COMMONWEALTH OF VIRGINIA
DEPARTMENT OF HEALTH
CERTIFIES THAT
Academy Subs, Inc,
is hereby granted a. permit/license to operate a. Fast Food Restaurant
by the Albemarle County :Health Department in accordance
with the regz lations of the Board of Health,
Commonwealth of Virginia..
FACILITY NAME: NEWCASTLE SUBS
PHYSICAL ADDRESS: 3440 Seminole Trail
Charlottesville, Virginia 22911
MAILING.ADDRESS: 321 Eastbrook Drive
Charlottesville; VA 22901,`
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, PLw pk %E sk-KISS
[County application name and number]
was provided to l,(,� 5 . L-L -- the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 3oZ� b� U�� ()" o7A'� U by delivering a copy of the application in the
r ' entified below:
manne
Hand delivering a copy of the application to(1`i�
[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 15-/ 1 -R, ) I -�
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
Date
to the following address:
[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].
Print Applicant Name
x/3/3
D to
f `+
V '
1
ca
a
m
d