HomeMy WebLinkAboutCLE201600235 Application 2016-10-12I
Application f r Z Wing Clearance
CLE #r'
OFFICE NLY
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff: �v
PARCEL INFORMATION
Tax Map and Parcel: 0 — (9— O0 - 9 A tr-) Existing ZoninLy
Parcel Owner • J l� $ M
Parcel Address:_ -392-4- Lr--Acx ityi City _ iyr-State V 4 Z;p
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address : !•o N {-� Ciry �I4� State zip3z114-
Office Phone: ( Cell # JoG.]i�ax # J�' 9 ^D¢'rmail ad4Y���r►� ,
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: 72FESTAU T
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:—1����P7`Zi�_--�±
*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. 1 have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed ,�'�
PROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ J Denied
"t'
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
plan.
[ ] This site complies with the site plan as of this date.
Notes•
Building Official Date tc
Zoning Official Date
Other Official ' Date All %x
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
4--
Revised 11/1/2015 Page 2 of 3
Intake to complete the following:
Y /O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
PilN
l there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approvahfrom Health
Dept, FAX DATE o b ^ yec ZjV 2V
Circle the one that applies
Is parcel on private well o c wa r?
If private well, provide Hd#jtthLpAmi1ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap
Is parcel on septic or b is sew .
fi'/N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit,
Permit #
/ N
II there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning= to complete the followine:
Reviewer to complete the following:
Square footage of Use:
Permitted as:
Under Section: Q
Supplementary regulations section:
Parking formula:
ii
Required spaces: a
YI TV
Items to be verified in the field:
Inspector • Date:
Notes:
i
Violations:
offers: -
Y/t
/N
If ist:
If so, List:
— 7 0/1- „
2 a 0— ...
—.._..._
0a — 9
Varia e:
Y/
Y
If so, List:
If so, List:
Clearances:
SDP's
Revised 11/1 /2415 Page 3 of 3
COMMONWEALTH OF VIR GINIA
VIRGINIA DEPARTMENT OF HEALTH
In accordance with the regulations of the Board of Health of the
Commonwealth of Virginia this certifies that
BJ's Restaurants
is hereby granted a permAllicense by the Albemarle County Health Department to operate a
Full Service Restaurant
Trading as:
BXS
Located at:
The Shops at Stonefield
Charlottesville, VA, 22901
Mailing Address:
7755 Center Avenue 300,
Huntington Beach, CA, 92647
Conditions (if applicable):
Date of Expiration
October 31, 2017
M. Reed CranfoVEHS, CP=FS
Environmental Health Specialist, Sr,
THIS PERMIT IS NOT TRANSFERABLE FROM ONE INDIVIDUAL OR LOCATION TO ANOTHER
New owners are required to make written application for a permit.
Please Direct Questions or Concerns to the
Albemarle County Health Department
Environmental Health Services
PO BOX 7546
Charlottesville VA 22906
(434) 972-6219