HomeMy WebLinkAboutCLE201600170 Application 2017-03-16Application for Zoning Clearance
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PLEASE REVIEW ALL 3 SHEETS
OFFICE Ov Y p
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: Existing Zoning PD-MC
Parcel Owner: 5th Street Station Ventures LLC
Parcel Address: 245 Merchant Walk Ave., Suite 1225 City Charlottesville State Virginia
Zip 22902
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Dan Tucker
Address : 5 SW Broad Street, Suite B City Fairburn State Georgia
Zip 30213
Office Phone: 7( 70) 692-8300 Cell # (434) 245-4909 Fax #.. (770) 692-8302 E-mail _dan6bsicollinsent.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name
x New business
Business Name/Type: VerJ��ntile AE 'a, LJ? 0
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Previous Business on this site mostly undeveloped site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles. and nnv ndditinnni tnfnrmotinn th.t . -A Thie i 9r)n o f.,.,t Q.,.f KA. /n m
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business has
*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 s Printed
APP� AL INFORMATION
[�J�4pproved as proposed [ ] Approved with conditions [ ] Denied
[ J Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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.
Notes:
Building Official Date % Z f f f ,
Zoning Official Date
Other Official L �� �i c 2/� Date I I
County of Albemarle Department of Community Development
401 Mclutire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/l/2011 Page 2 of 3
Intake to complete the following:
Y /IN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
' / N
'ill there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin untilwe receive approval from Health
Dept. FAX DATE , ;-OA
Circle the one that applies
Is parcel on private well or ub is w
If private well, provide Healt epartmeut form.
Zoning review can not begig until we receive approval from Health
Dept. FAX DATE 2
Circle the one that applies
Is parcel on septic o public se ?
1
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # G ,qc l s /�— 13413
Reviewer to complete the folio«ring:
Square footage of Use:
U/ N
Permitted as: 1
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
YIki
Items Me verified in the field:
Inspector : Date:
Notes:
Zoning to complete the following:
/ IF
ffers:
�
N
[Violations:
so, ist:
If so, List:
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Varia
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SP's:
Y/
If so,Zist.
If so List:
Clearances:
SDP's
Revised 7/l/2011 Page 3 of
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This forin must accompany zoning applications (Horne Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Perinits, Building Permits) if the application is not the
owner,
I certify that notice of the application, Application for Zoning Clearance - Hand and Stone
[County application name and number]
was provided to 5th Street Station Ventures, LLC - Dan Tucker
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[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
X Mailing a copy of the application to 5th Street Station Ventures, LLC - Dan Tucker
[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 03-01-16
Date
to the following address:
5 SW Broad Street, Suite B Fairburn GA 30213
[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
Print Applicant Name
Date
COMMONWEALTH OF VIRGINIA
VIRGINIA DEPARTMENT OF HEALTH
In accordance with the regulations of the Board of Health of the
Commonwealth of Virginia this certifies that
Zhu, Winnie
is hereby granted a permit/license by the Albemarle County Health Department to operate a
Fast Food Restaurant
Trading as:
RED MANGO/NESTLE CAFE
Located at:
245 Merchant Walk Avenue Suite 1225
Charlottesville, VA, 22902
Mailing Address:
245 Merchant Walk Avenue Suite 1225,
Charlottesville, VA, 22902
Conditions of Permit (if applicable);
Date of Expiration
March 31, 2018
Casandra Styles
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