The URL can be used to link to this page

Home My WebLink AboutCLE201700033 Application 2017-02-15Application for Zoning Clearance.,��' CLE # 2& 35 OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # Date: L Receipt # � (��' � <(� j Staff: _ J PARCEL INFORMATION pa Tax Map and Parcel: �" Existing Zoning l� ! �� i l►l( ; Pa reel Owner: Parcel Address: City �1r�lState if Zip (include suite or Toor) PRIMARY CONTACT Who should we call/write concerning this project? Address : ,l�L(�Z� % City` �� G State / / Zip 2 Office Phone• OX Cell # l a1+ x # E-mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: L Previous Business on this site_ _ 1-7-�� Describe the proposed business including use, number of employees, number of shifts, available parking spa cg�, number of vehicles, and any 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 accura the best of my knowledge. I have read the conditions of approval, and I understand them, and th t I will abide by them. Signature Printed AP�VAL INFORMATION [ Approved as proposed [ ) Approved with conditions [ ) Denied [ ) Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17. [ ] 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. Building Official Zoning Official Other Official Date — --� Date 9-' 1 5 f / �— Date 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 Is use in LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified ,Y / N Will there be food preparation? If so, give applicant a Health Departmggnt form. Zoning review can not begin until we�receive ap roval fr m H Ith Dept. FAX DATE Circle the one that applies Is parcel on private well pu�wate If private well, provide Hearm. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appl' Is parcel on septic r public sewer? Y /CNN Will you be putting up a new sign of any kind? Sign permit. Permit # Reviewer to complete the following: Square footage of Use: I l.f' t/ ?ermitted as:'�" QI� tVli� lU C-h oa) I Under Section: Supplementary regulations section: Parking formula: 641' �� 1( I Required spaces: lt IN J t Ite a verified in the field: If so, obtain proper Inspector • Date: y' • % Notes: Will'there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the followin Violations: Y/N If so, List: Proffers: If y2ist: Variance: Y/N If so, List: SP's: Y/N if 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. I certify that notice of the application, C_L�_ 20 i T - 5 [County application name and number] was provided to PKI � the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number B by delivering a copy of the application in the manner ' entified 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 �C '" / — to the following address: Date [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 Name z-2 -1 7 Date � � \ ƒ\ > k � COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH CERTIFIES THAT Litt/ejohns Restaurants, LLC is hereby granted a permitilicense to operate as a Fu// Service Restaurant by the Albemarle County Health Department in accordance with the regulations of the Board of Health , Commonwealth of Virginia. FACILITY NAME: LITTLEJOHN'S DELI PVCC PHYSICAL ADDRESS: 501 College Drive Charlottesville, VA 22911 MAILING ADDRESS: 501 College Drive Charlottesville, VA 22911 EXPIRATION DATE: August 31, 2017 CONDITIONS: w Fulton Environmental Health Specialist, Sr. 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.