HomeMy WebLinkAboutCLE201500079 Application 2015-05-18Application for Zonin Clearance
Is-
CLE # A 6115_ — 7
OFFICEUS ON�;Y
"11 �t a i
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # "l fo Staff: A-19 -Q ,
PARCEL INFORMATION '
Tax Map and Parcel: �) ,/_/'& + ;+ Existing Zoning
1
Parcel Owner:
Parcel Address: .pzP /gid_ 9& &��r - City C44L*&- Sftate Zipg
include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address : zS y 0 4 w0 A".'e City Cf&Z&&P tate 11 "!Emy"t Zip 2za
Office Phone: 3 �} ' -vv c /' Cell # 3 o zo' Fax # E-mail �Cy1 ��,�c�k%;� �u.
APPLICANT INFORMATION
Check any that apply: __V Change of ownership Change of use Change of name New business
Business Name/Type: ICL fJZ�_Q
Previous Business on this site
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: :? -- U
*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 �2,� 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 `-t
Zoning Official Date S/j/�Ao
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
DO
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.
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
Circle the one that applies ``�
Is parcel on private well or ublic water
If private well, provide Health epariment 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 ublic sewer
Y /,CN)
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y
Will ere be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:�a'1'��
O/ N
Permitted as:
Under Section: Z> • %
Supplementary regulations section:
Parking formula: ✓4,yfi
Required spaces:
Y/1V
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/
If so, t:
Proffers:
OIN
If so, List:
Variance:
-0/N
If so, List:
SP's:
(9/N
If so, List:
Clearances:
SDP's
Z� 2—
c> 2 Y
Revised 7/1/2011 Page 3 of 3
COMMONWEALTH OF VIRGINIA
DEPARTMENT OF HEALTH
CERTIFIES THAT
Li, Zhiging
is hereby granted a permit/license to operate as a
Full Service Restaurant
by the Albemarle County Health Department in accordance
with the regulations of the Board of Health ,
Commonwealth of Virginia.
FACILITY NAME: KYOTO
PHYSICAL ADDRESS: 1664 Rio Hill Center
Charlottesville, VA 22901
MAILING ADDRESS: 1864 Rio Hill Center
Charlottesville, VA 22901
EXPIRATION DATE: April 30, 2016
CONDITIONS:
M.L\Rexroad
Environmental Health Specialist
Please direct questions o;- concerns to the
Albemarle County Health Department,
Environmental Health Services, (434) 972-6219.
This Permit Is NOT TRANSFERABLE From One Individual