HomeMy WebLinkAboutCLE201400152 Application 2015-04-16I4D
Application for Zonin Clearance�'�,,
CLE # 2-0)
":���
� /t70lN�P
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE O1 �LY� , /
Check # G�+S Vl Date: 7
Receipt # � % y Staff:
PARCEL INFORMATION n
Tax Map and Parcel: j y y — Existing Zonin or _ 1` UYI*l Are,
Parcel Owner se
Parcel Address: 295r) City S(c,A+S \ji1Ie– State V iroini 5 zip LLS-90
(include suite '.61. floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
t p�
Address: `ISD,� QCn,Ae^n� f.� City Sc- �i svt�lz State U K
�Z�ipQyS90
Office Phone: (� Cell #L���' ��ot"6a39 Fax # E -mail �S I �v e,� M�.1rvi*� s
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use V Change of name New business
Business Name /Type:
Previous Business on this site E%C- k—e,—) e-(
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: C S J 4-4-4.
P a:,�iA - yw,r
*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 that I will abide by them.
Signature �J Printed cs I?, 14t\
APP OVAL INFORMATION
[ VTApproved 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 -Cl- Date
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 7/1/2011 Page 2 of 3
s
i
Viol ns:
Y/N
If soot:
,4f- ^ V bV
W
Intake to complete the following:
Reviewer to complete the followin :
Y /�!)
Square footage of Use:
1 d
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
/ N &Y+ I ,ab JILt Will there be food prep olunii
If so, give applicant a ealth a
Qr/:itted as:
Under Section: a
SP's•
Y .
If s Est:
Zoning review can not begin from Health
Dept. FAX DATE
Supplementary regulations section:
, r
Circle the one
Parking formula:
Is parcel o �well ublic water?If
SDP's
Required spaces:
private we h Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Y/N
Circle the9pplies
Items to be verified in the field:
Is parcel �_j,`�, septic r public sewer?
Y/N
you be putting up a new sign of any kind? If so, obtain proper
Sign permit. ,n D
Permit # I4IJi
Inspector : Date:
r{�t.-
YP
Notes:
Will t ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7nnina to nmmnlPtp the fnllowina:
Viol ns:
Y/N
If soot:
Prof r
Y/N
If so, .
Vari ce:
Y/
If so, ist:
SP's•
Y .
If s Est:
Clearances: n' T
ll�t
SDP's
Revised 7/1/2011 Page 3 of 3
n q.
e d
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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
the owner of record of Tax Map
by delivering a copy of the application in the
Hand delivering 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
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].
Sign ature of Applicant
Z�C�.r Ic S mc-r- 4-i
Print Applicant Name
FS"- IS-1 1.r
Date
EN
Z)
40
0
Commonwealth Of Virginia - Department Of Agriculture & Consumer Services
Food Safety and Security Program
PO Box 1163 - Richmond, VA 23218 - 804- 786 -3520
Firm # 1973301
Firm Name: Route 620 Stop -N -Go Phone: 1973 962 -6039
Address: 39:17 Rolling RD Scottsville, VA 24590
Attention: Mc Charles S Marlin II,Owner Purpose(s): Routine
Extent: Full Inspection Inspection ID: 913901 Start: 02/20/2015 End: 02/20/2015
Retail Inspection Report _
_ — -- _
�_._ - - .__.1_ .
N =in com lianco OUT -not in compliance NFl =nolajplicable .NO =not observed COS = corrected on -site during ins x;GiunIt pro coal vie ahon
COS R
Compliance Status COS R Compliance Status
- Safe Food & Water
Supervision
- -- - "- - - --- - - -- -- 27 IN Pasteurized e s used where rec�ulrecf -"
Person in charge present, dc:numslratns knowledge, & g- -- -- "'
1 IN 281 IN Water & ice from approved source
Health 29 NA Variance obtained for speclalizec�>rocessin� methcxl
Employed :;
_ -_-
-- Food Tem erature Control -- _._ - - -__
2 IN Management, foal employee and conditional employeD;� P
knowledge, re5Ln%ibililios and icporliix _ _ --- 30 IN Proper cooling control
is used; arioquale equipment for
3 IN Proper use of rc'porhng," roslrir,Uon &exclusion " tem erature control _ - -- _ _._.._ ___. _ ^ - - --
_ - --
3 I Hygienic Practices 31 IN Plant food ropotly cooked fo; hot holding __- _— __ -, -.- _..._...
- y - - - - -- -- _ -- --
��_�4 IN Proper Dating, taslin rinkin% or tob tceo rut _ _ -_ 32 IN Approved lhawutg molhod a ;n tl - —
eyes, _ _ ..._{ 33 IN The cation ors p;ovldDd & rn cur dp
5 IN No dischar e from nose., and mouth -_
-- - Food Identification
Preventing Contamination b Hands - -
y --- IN Food property IabelDCf ongutal container --
6 IN Hands clean & prpperiy - — -
-- _
7 IN No bare. hand contact with ready to -Dal locxl:, or' pin: lnpprn>ve.d Prevention Insect
Contamination
alternate method properly followed _ 35 IN Insects, rodents, & animals notPresent_
8 IN Adegualo handwashirtg (nullities supplied & accost ibis __ 36 IN Contamination prevented during food preparation, storage &
Approved Source ells la - -. - --
- -" - "- 37 IN Personal cleanliness
9 IN Focxi obtained from a ALrovod source _ - -"
10 NO Food received aa�roper terrtperature 38 IN Wi in cloths: ro rl used &stored
391 IN lWashingtruits & ve etables
11 IN Food in clood condition safe., & unadulteratDd pro per Use of Utensils
12 NA Required records available: shellstock tags, parasite P
destruction IN In -use utensils: ro eri stored
destructle_4_17N_
41 IN Utensils equipment & linens: properly stored, dried, & handled
Protection from Contamination
13 " IN Food separated and protected 42 IN Sin le -use & single- service articles: ro erl stored, & used
14 OUT Food - contact surfaces: weaned & sanitized 43 IN Gloves use(]
erl
15 IN Proper disposition or rotu revi
med, pously served, Utensils, Equipment and Vending _
_ reconditioned, & unsafe food 44 IN Food & nonfood - contact surfaces cleanable, properly
Potentially Hazardous Food (TimelTemperature Control for Safety Food) designed, constructed, & used
16 NO Proper cooking time & temperatures 45 IN Warewashing facilities: installed, maintained, &used; test
17 IN Proper reheating procedures for hot holding strips
-- - - - " -- 46 OUT Non -food contact surfaces clean
18 IN Proper cooling time & temperatures physical Facilities
19 IN Proper hot holding temperatures -
20 IN Pro per cold holding temperatures __- _ - -__ 47 IN Hot and cold water available; ade uate ressure
21 NA
Proper date markin & dis . ositimr _ ____ 48 IN Plumbing installed; proper backflow devices
221 Time as a public health control: procedures &records 49 IN Sowa e &waste water �ro Dri dis osed
-�- --- 50 IN Toilet facilities properly constructed supplied, & cleaned
Consumer Advisory _.._ -... __._.
1 - 51 IN Garbage & refuse properly dis sed; facilities maintained
23 NA Consumer advise rovided for raw or undercooked foods 5
Chemical 2 1 N Ph sical facilities installed, maintained. & clean
- ___- ..._....._....._..._._.__. -.__ _._ -. _ - -• - 531 IN jAd0qUate ventilation & lidhtinc�_deslgnated areas used
24 NA Food additives: a proved &_properly used __.- .___ -,.,- -- preoperational Inspections and Plan Approval
25 IN Toxic substances ro edyidenlified, stored, & used - - "-
Conformance with Approved Procedures 54 IN ]Preoperational inspection ,nation conducted — Compliance with with variance, specialized process, and I-IACCP r Health Hazards -
1
26 NA Ian _ _ _ 55 NA Cease o orations during certain circumstancDs
Establishment (S gnature) / Received By Title Ow
;harlrs S. Martin IIf1e1
Inspector (Signature)
Olinger, Allyn
I P
A t,
Firm # 1973301
Firm Name: Route 620 Stop -N -Go Phone: (434) 962 -6039
Address: 3937 Rolling RD Scottsville, VA 24590
Attention: Mr. Charles S Martin II,Owner Purpose(s): Routine
Extent: Full Inspection Inspection ID: 913901 Start: 02/20/2015 End: 02120/2015
Protection from Contamination; #14: 2VAC5- 585 -1780 — Equipment food - contact surfaces and utensils. Accumulated old food residue was observed on the blade anc
framework of the slicer in the deli.
5 -1800 — Nonfood contact surfaces. Accumulated old grime was observed on the floor beneath the counters where
Utensils, Equipment and Vending; #46: 2VAC5 -58
the equipment sink is located in the deli. Title
EstaPli�merJt (Sigrt>�ture �r �. Received By Owner
/ AY i/ r h'' Charles S. Martin II
Inspector (Signature)
Olinger, Allyn
Community Development Department
Cover Sheet for Items Left in Pick -Up Tray
(Cover Sheet must accompany any items left at Front Counter)
Today's Date: q16116
To: _jY V a AA V1
From: S
I
* Pick -up Date. I 5 /
Phone
Extension Number DOt
NO-
Fee: (If applicable) $
Other Comments:
C&A T�U)Cls <�
Item Returned By �1 COV- (qA � f & Date
* Items not picked -up within two (2) weeks of Pick -up Date will be returned to sender.
1/23/2015
�S
<z- t�
I
a
pop }o' 1
ALBEMARLE COUNTY CODE
Written approval of the adequacy of the structures intended for human
habitation by the building official.
Upon the zoning administrator's determination that all requirements of the zoning
ordinance are satisfied, that all conditions of the special use permit authorizing a farm
worker housing, Class B, facility, are satisfied, and upon receipt of the approvals and
documents required in section 5.1.44(h)(2), the zoning administrator shall issue a zoning.
clearance for the facility.
Use of farm worker housing facility by workers and their families only. A farm worker housing
facility shall be occupied only by persons employed to work on the farm on which the structures
are located for seasonal agriculture work and their immediate families as provided herein. For
purposes of this section 5.1.44, the term "immediate families" means the natural or legally defined
off - spring, grandchild, grandparent, or parent of the farm worker.
j. Use of farm worker housing facility when not occupied. When not occupied by seasonal farm
workers, farm worker housing facilities may be used for any use accessory to a primary agriculture
use.
(Ord. 06- 18(2), 12- 13 -06; Ord. 12- 18(4), 7- 11 -12)
5.1.45 COUNTRY STORES
Each country store, Classes A and B, shall be subject to the following, as applicable:
a Count y sta e' ,,Class A,Each country store, Class A, shall be subject to the following:
1. Primary use. At least fifty -one percent (51%) of the gross floor area of a historic country
store building shall be used as a country store, including accessory food sales and interior
seating for accessory food sales as provided in section 5.1.45(a)(2)(a).
2. Accessory uses, The following uses are permitted as accessory uses:
a Accessory food sales. Accessory food sales- mayJnclude; but; are: notY
limited to, luncheonettes; '-snadc bars; feffeshmaht`- lands and other restaurant
uses. .Interior,' "seatine for: lunelleonettes, " "snack" bars,- refreshment,; stands ;-arid
floor area of the country store use. An additional twenty percent (20 %) of the
total gross floor area of the country store use shall be allowed as exterior
seating.
Single family dwelling and offices. Up to forty-nine percent (49 %) of the gross
floor area of an historic country store building may be used for one single family
dwelling and /or one or more offices.
Exemptions. Country stores, Class A shall be exempt from sections 4.1.2, 4.1.3, 4.12.6,
4.12.13, 4.12.14, 4.12.15, 4.12.16(x) and (b), 4.12.17, 4.12.18, 4.12.19, 6.3 (B), (F) and
(G), 6.4(D), 32.7.2.7, 32.7.2.8, and 32.7.9.
Building size. An historic country store building shall not exceed the gross floor area of
the building as it existed on November 12, 2008 or four thousand (4,000) square feet
gross floor area, whichever is greater.
Front yard setback. The following minimum front yard setback shall apply:
18 -5 -22.15
Zoning Supplement #79, 5 -8 -13
i
Department of Alcoholic Beverage Control
2901 HERMITAGE ROAD
P.O. BOX 27491
RICHMOND. VIRGINIA23261
April 16, 2015
To Whom It May Concern:
PHONE (804) 213 -4400
WWW.ABC. VIRGINIA.GOV
This is to inform you that a retail application has been received from an establishment that is located in Albermarle County.
The following is the basic information pertaining to the application:
Application Number: 87308
Company Name: Route 620 Stop N Go Market LLC
Trade Name: Route 620 Stop N Go Market
Address, City, State & Zip Code: 3937 Rolling Rd Scottsville, VA 24590 -4325
Type of Establishment: Restaurant
Type of License Applied For: Beer On & Off Premises
Date of Receipt: 3/24/2015
You are receiving this email notification per Code 4.1 -230 -B which states:
"Except for applicants for wine shipper's, beer shipper's, wine and beer shipper's licenses, and delivery permits, the
Board shall notify the local governing body of each license application through the county or city attorney or the chief law -
enforcement officer of the locality. Local governing bodies shall submit objections to the granting of a license within 30 days
of the filing of the application."
Please feel free to contact our office at (804)213 -4665 if you have any questions, need any further information or wish to file
any objections against the above listed application. Please be sure to reference the license number listed above.
Thank you,
Lisa Thompson
Licensing Technician
License Records Management
(804) 213- 4665
(804) 213- 4592 (fax)
Lisa.Thompson @abc.virginia.gov