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Home My WebLink AboutCLE201500192 Application 2015-10-12Application for Zoning Clearance CLE #_ C)ls-=19a 0— OFFICENLY PLEASE REVIEW ALL 3 SHEETS Check# W Date; -l` Receipt # Staff; .� PARCEL INFORMATION N r% o Tax Map and Parcel: 055 C6 - OI - n O - 000 C 0 Existing Zoning X F Dy Parcel Owner: AA tggc+f iuioual 7A=A-J p t7 ZE3 , CCC --r Parcel Address: 10154�!:06zcdf7- CcR 41L+ w00 City a lzo U T State VA ZipZ�`z (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? &AJ kkUntl Address: f$Vy i7al-f DO. Od' frs3 City C&'ZE'7 -_ State ✓A ZipTZ Office Phone: k{kj 9Z'3-frtoy' Cell #q3(1 -9U- 0WFax # -®14l- I VE -mail WFILIP f6t4gaa4 ;4 c .Gc�•�i APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Wic Business Name/Type: uei\ V� a,,J C)VA4 & "- Previous Business on this site Ltv' 6 Describe the proposed business including use, number of employees number of shifts, available parking spa�es, nu ber of vehicles, an any additio al info/rm ion that you c n provide: j',S 17Aft 14we, SPac&S , 4��iuA "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 avethe owner's mission to use the space indicated on this application. I also certify that the information provided is true and accur the best f o ve read the conditions of approval, I understand them, at I will abide by them. Signature / Printed APPROVAL INFORMATION TApproved 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: el Building Official Date ` t Zoning Officialje�Date �/1y312-1 _ Other Official AD Date ZO �2;D)iC 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 Intake to complete the following: YIN 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 wellublic water? 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 a Iles Is parcel on septic o ublic sewer? Y !j N y�j you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # YN 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: & !�-() LY/N Permitted as:—;;� Under Section:. 61.0 4!Ad V ,J Supplementary regulations section: Parking formula: Si Jt, 1 T J Required spaces: /-5 YIN / Items to be verified in the field: Inspector • Date: Notes: Violations: Y1/N If so, ist: offers: If so, List: Variance: Y/6) If so, List; SP's: 9j/N If so, List: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This farm 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, & 2 Lt CA rt o N FOP- &1,r-16 ( (. E4qAae-t- [County application name and number] was provided to U" MQUA q w N Pi -4T I �--S C the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 0 5 SJC- U 1 ` Au CQQ Gd by delivering a copy of the application in the manner identified below: q A . Hand delivering a copy of the application to +�V t ON f VUkNA,6_�-2 [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 C' 1 XII 15- 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 q- P4 5 Date COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH CERTIFIES THAT Fish West, LLC is hereby granted a permit/license to operate as a Fail Service Restaaraat by the Albemarle County Health Department in accordance with the regulations of the Board of Health , Commonwealth of Virginia. FACILITY NAME: PUBLIC WEST PUB $ OYSTER BAR PHYSICAL ADDRESS: 1015 Heathercroft Circle #400 Crozet, VA 22932 MAILINGADDRESS: 101.5 Heathercroft Circle #400 Crozet, VA 22932 EXPIRATION DATE: October 31, 2016 CONDITIONS: / n q (.(Archer Carnpbell,'REHS Environm ntal Health Technical Specialist Please direct questions or concerns to the Albemarle County Health Department, Environmental Health Services, (434) 972-6219. This Permit Is NOT TRANSFERABLE From One Individual or Location to Another.