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Home My WebLink AboutCLE201500060 Application 2015-04-23Application for Zonin Clearance CLE # a 0 l S- — 6 D �, , e }�• :- PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY r - Checic # Cs. Date: 7 Receipt # eq 2, 2 Staff: PARCEL INFORMATION DI) ayt &.1Tax �� ' �S i Existing Zoning Map and Parcel: 'f16h le -�a K-bou K Parcel Owner: 1 }� Parcel Address:�CpIo AbeChar��1��2State Zip`�0 (include suite o floor) PRIMARY CONTACTn �2� Who should we call/write concerning this project. , Address: Q a1000 City State ✓r -i ZipaLIGZ a Office Phone: 6� aan -330p Cell # (p(g0-`IN" 13 Fax # ..�- E-mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business {7Q1� �- ' �`� R( Business Name/Type:A-0(V Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces., number of Q- �Untrft a d vehicles, and ny additional information that you can provide: *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 Printed v t �"i &V-�f 6U � APPROVAL INFORAATION j Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117. inspection has been done for this clearance. Therefore, it is not a determination of cotnpliance with the existing [ ] No physical site site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official -' Date �d / E 6 Zoning Official / Da to 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 Floor M-nuil+vi B201q - 160 P H Gvm t'Jl Intake to complete the following: Y/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. �N Will 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 2a S Circle the one that applies T --- Is parcel on private well orblic wat •� If private well, provide Health 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 or public sewer? Y)/ N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y'� N 111 there be any new construction or renovations? If so, obtain the proper Permit. Permit # A 2 d4i Zoning to complete the following: Reviewer to complete the following: Square footage of Use: I �D e o IJ / N Permitted as: I A Under Section: mil 4 2 Supplementary regulations section: Parking formula: Required spaces: Y/ itemVo be verified in the field: Inspector : Date: Notes: Violations: If o, List: Proffers: D/ N If so, List: 2d Variance: Y/(j/N If so, hist: S f so, List: ? l o/� Z Clearances: SDP's Revised 7/1/2011 Page 3 of 3 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, [County application name and number] was provided to the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number manner identified below. 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]. Signature of Applicant Print Applicant Name Date COMMONWEALTH of VIRGINIA In. Cooperation with the State Department of Health Phone (434) 972-6219 Fax (434)972-4310 08/26/2014 Ashley Harbour A .Harbour Inc. 6200 Fort Ave Lynchburg, VA 24.502 Thomas Jejftrson Health Distriet 1138.Rose Hill drive R O. Box 7546 Charlottesville, Virginia 22906 RE: Jersey Mikes Subs 2040 Abbey Rd STE 104, Charlottesville, Virginia 22911 ALBEMARLE•CHARLOTTESVILLE FLUVANNA COUNTY (PALMYRA) GREENE COUNTY (STANARDSVILLE) LOUISA COUNTY(LOUISA) NELSON COUNTY (LOVINGSTON) Dear Mrs, Harbour.: Based on the .information provided in your plan review submission packet, your plans are approved with the following additions l: The Virginia Food regulations require a designated. Person -In -Charge (FIC) who can demonstrate food safety knowledge and who can monitor food -service employeelprocedures .to prevent critical type violations (poor hand washing, improper. food temperatures, inadequate cleaning and sanitizing, etc.). The PIC is also responsible for training employees in company health policies such as reporting certain diseases to management. The PIC or their designee is :required to be present at. all times during hours of operation. Therefore, it is strongly recommended that a PIC will have or obtain a food manager's certification from an accredited agency. 2. An employee health policy is required. for all food -service establislunents. A. guidance document is enclosed for your review;-. 3. The deli meats slicers must be wash, rinse, and sanitize throughout the day at least every four hours. 12 VAC 5-421-1780 (C) 4. Hand sink signage is requiredat all hand -washing sinks. It is important that any deviations from your submitted and approved plans be first reported to this department for approval Failure to do so may result in a delay of the Facility's opening In additional, a satisfactory pre -operational inspection is required by this department before issuance of a food operating pernA Please nat fig this office to schedule this inspection at least 48 hours prior to your.planned opening date. A copy of the Virginia Food Regulations which. govern. food service facilities in the Commonwealth can. be found at the following website: http://www vdlivirginia gov/FnvironnlentalHealtli/Food/Regulations or a copy can be purchased :from this department for a fee of $6.00.. Please call me to schedule an inspection once the item noted above is corrected. If you have any questions pertaining to this matter or wish to schedule an inspection, please call me at (434) 972-4311 Sincerel. ason Fulton, Environmental Health Specialist, Senior.. Pc: Eric S. Myers, REHS EH Supervisor Thomas Jeffers Health District