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Home My WebLink AboutCLE201600264 Application 2016-12-13Application for Zoning Clearance OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check# j -2Date: 1/ Receipt # J P Staff: - __- PARCEL INFORMATION Tax Map and Parcel: Existing Zoning Ci Parcel Owner: �j.7F C , l (` Parcel Address:3, qqc) M')n4, 7rc,i J City � �� tate Zip ` l (include suite or floor PRIMARY CONTACT Who should we call/write concerning this project? Address : lYn(ornwwnyi ei , 14A, 'I),-_ City c ( State ),a ZipUaDj Office Phone: ( 3q) .335 - Cell # Fax # E-mail APPLICANT INFORMATION Check any that apply: Change of ownership- Change of use Change of name New business Business Name/Type: Coo C.G. \:2p'5 F"k}<IC G�hS+CL)C?-,f1—_ Previous Business on this site_m i—a^SC,_ Describe the proposed business including use, number of empl2yees, number of shifts, available parking spaces, number of vehicyeS, and any additional information that you can provide sz �� i�,�Q �� \ � ; D lns I I �n(wo 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 st of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed I r�rt APPROVAL INFORMATION [�Q 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 �r_ �- Date / Zoning Official r ��`�' Date L24A�� Other Official 11 Date "�-I s 11 County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised I I/1/2015 Page 2 of 3 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 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 /J- 2_ZII Circle the one that applies Is parcel on private well or �eparltament ? If private well, provide Healtform. 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, Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zonine to complete the following: Reviewer to complete the following: Square footage of Use: 6)/N 1 Permitted as: QSIGU ra /) J Under Section: -2 7 •2 - Supplementary regulations section: Parking formula: 13 Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Violations: Y/ If so, ist: Proffers: V/N If so, List: Variance: (V/ N If so, List: SP's: N rf so, List: Clearances: SDP's Revised 11/1/2015 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. 1 certify that notice of the application, [County application name and number] was provided to l) r`~ ./� L L L the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 3 a 00100 03 2 elivering a copy of the application in the manner identified below: 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 br, K ✓ail, Print Applicant Name 1112--I6 Date On as e on a•nlna,wU MAMOMIUOT Ftumn•atom UwWaWU@n Foodservice Facility Plan Review Evaluation C1W101tesv111e/AraeMarrr 138 Roue Hill Drtm ChadvfreMUe, YA 22P03 P. 0. Box 7546 Owtortesvtlls, Yet 22906 Phw. (ISI) 972.62J9 Fax: (434) 972.021 Rod d I eostatt the earth Dq artmeat white optoiog anew esubtlshmtat ar when seWat or troodario= mmership of my rertannalt Tho Flaltb tltarnk be oaa odtltia first apeaaa ooataud v►Oseotver a � of oa�nashlp or wasauaiaa of a Deus >�' 0 ekes. Ratasuaat paastts are 'the Y�tRro iyod ngdm dut ft now owner rubmlt a ylan mYlaw tpylleesiaa fora rasaunet paml< Once ptaaa Ira •pprored than fnsm wR! 1<es wititd to the Coral laiJ im�aotl� aIlawiat duns to issuo your bu0dlnt penult and business Vaasa Asnkamorr, a plmrEfog rovSrtn Doti an opaoing hsspecdaas is segodred prtorso a pemstt w du sew owns. Bow nee no Igo attar I subzdt a •duW of ownersh1p° swadoot ?ha lssmaoa ota taaw permit east fist tegd4ry aabstaadol hc* aawatlonr and uppd= It Is reoommeaded that dw owaar and prospeaivo buya submit ft osNtaed below am dim woop o hsrpediaa with the Haab Depatateat to awn Uthom an uppades to the wplFinaa at Rallry that wW be toqulnd Orr tso blahs a cow pawt. 7 Whyam _ (Ike new MV) bdq Foed = daded It $egaa * �� who upda" Whtor o 0 mumat andava a owner bad cm Inhop tfow dw tidk Is then treated as a bread am 8nbsegnu*, tine Raft must dim rota sabst oU oompltrmoa wbh dw moat eusm Yaslon cribs Vk*k Food Rttu4ttoas befbro a permh an to issaad {are tho praviaos gaestfeo} Now an I obtata a copy of the cement vailon of the HqWi Pbod Agzkdw1 A Rtsdted plu ass tavdisblo tbrpmehaso d yom Ioal health depasoMI orrice, or you case vidt tho Vlydiala Depa to aat of Flaabb webs lu (wward3 so obtata sa dotssro:de vcrsloa � Building Permit # C- ILL- An%0 _- )(J�)11 Name of foodservice establishment~ _ �r'A.� �.� h[>_�� W-Y- i rri n Doc 4n , )gran+ Uc Name of Owner. -E— (I AtU(x Type of Ownership: Individual Corporation LLC Facitlty Address: 3y.�;;n,�1 Telephone Numbers:(4,N) 7)O i = 7 Z 1 (Tir Contact Email Address: Plans and Information Submitted By: 1 MWl TYII, ., /.1 -/1Z /(, Anticipated opening date: � a- RO , -kt L to Seating capacity So Type of Menu-PIows check all that apply: flillservitx Fast Food Gourmet Carryout Caterer School Public or Private Daycare Group Home Grocery Stop In dwdon Type Nursing home —Hospite _ 1cte1 Continental Breakfi st Mobile/pnsb cart Seasonal Type Information to be submitted to Environmental Health Department: Menu Equipment numbered on floor plan drawn to scale Plan review applleation Pay plan review and annual permit fees Annual peanit applitadon Equipment specification sheets and plumbing diagram Type of Water Supply:or Private Noncommunity? YES NO Approved // Approval Date: Type of Sewage System: 04tibIia Approved: 0 YES ONO O Private Approved: 0 YES 0 NO Date: Environmental Health Approvat/Denial: Approved by:� xlQ�v. �.Ji�t , .. Date: 13 1 U, Casabels Mexican Restaurant, LLC Albemarle County Health Department PO BOX 7546 Charlottesville, VA 22906 Phone: (434) 972-6219 Fax: (434) 972-4310 URL: COMMONWEALTH OF VIRGINIA VIRGINIA DEPARTMENT OF HEALTH Foodservice Establisl-unent Evaluation Report Establishment Information Establishment Name: Casabels Mexican Restaurant, LLC Establishment Type: Full Service Restaurant Address: 3440 Seminole Commons 101 Charlottesville, VA 22911 Evaluation Information Inspection Type: Pre -Opening Evaluation Date/Time: December 12, 2016 11:30 AM to 12:00 PM Evaluation Length: 0.5 hour(s) Equipment Temperatures Description Temperature IF Small Chest Freezer -10 Large Chest Freezer - Back 0 Walk -In Cooler 35 Prep Unit 38 Person In Charge Person In Charge: Observations Total Number: 0 Comments Pre -Opening Inspection. Facility expects to open on or about 12/20/16. Facility to order chlorine test strips for the dishmachine and three compartment sink prior to opening. Facility is approved to open. The permit will be mailed or available for pick up. The above listed observations, violations and specified periods of time for correction of the violations are issued in accordance with the Food Regulations. It is the responsibility of the permit holder "to comply with directives of the regulatory authority including time frames for corrective actions...." An opportunity for a hearing on the inspection results, a time limit, or both, shall be granted provided that a written request is filed with the local health department within 30 days following the inspection report. Received by E H S Page #1 of #2 Albemarle County Planning Application Community, Development Departr 401 McIntire Road Charlottesville, VA 22902-4! Voice : (434 295-5832 Fax: (434) 972-41 TMPI 03200-00-00-037AO Otvner(S): SOFIA 29 LLC Application # ECLE2016002§6 .OPERTY INFORMATION Legal Description ACREAGE Magisterial Dist Rio Land use Primary Commercial Current AFD Not in A/F district + Current Zoning Primarl Highway Commercial APPLICATION INFORMATION _ Street .Address 13440 SEMINOLE TRL CHARLOTTESV'ILLE. 22911 Entered Application Type Zoning Clearance lifer Pritchett j �`� 1i -- Protect Received Date il/30f 16 Closing File Date Revision Plumber F Comments Legal Ad .�vn HrrL1�.Hllyty(SJ Received Date Final E:== Submittal Date 11/30/16 Total Fees Submittal Date Final Total Paid ication APPLICANT / CONTACT INFORMATION Signature of Contractor or Authorized Agent Date Address Phone £