HomeMy WebLinkAboutCLE201700073 Action Letter 2017-09-12Application for Zoning Clearance"
CLE # �;1-1- -1 �x = ,:,� �N
� � il�,1p�Pr
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # I ". ci Zl Date: U }_l
Receipt #
PARCEL INFORM I
Tax Map and Parcel: r
14
� h�C L - 1 �S Existing Zoning I
Parcel Owner: ►�1
Parcel Address: •-'City �#fU flIOState Zip
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
1/'
Address :_ r`r1 (��C.�y �4-L� ''
�0- CityS t I C State V k Zip `� I
Office Phone: 4-f, Cell # 'Tbb' Fax`?# Of E-mail PAaV��Q �V✓L((.l4��j/i
APPLICANT INFORMATION
Check anFDescribe
that apply: ✓Change of ownership Change of use Change of name New business
me/Type: K'4: i-S E N0 0 1
siness on this site � /�/'A
e proposed business including use, number of employees, number o shifts, av ila a ar n spaces, number of d any additional information that you can provide:,-, G .o 4-ce will only be valid on the Vircel for which it is appppbved. If you change, intensify or ove the use to anew location, anew 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 f my knowledge. I have r d the conditions of approval, and I understand them, and that I will abide by them.
Signature �10e_
APPJOVAL INFORMATION
[LApproved 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.
Notes
Building Official Date
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
, (xi M_
Revised 11/1/20I5 Page 2 of
Intake to complete the following:
Y 'NJ
Is use in LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y J/ N
Mill 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 well Ctf publi�j)
If private well, provide Healt apartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies__
Is parcel on septic or bublic sewer? '?
Y / N
ill you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y rI/ N
mill there be any new construction or renovations?
If so, obtlpp,pro�e�1P�eytni,`�
Permit # 0p c u
IN
Zoning to complete the following:
Reviewer to complete the following:
footage of Use: I� V
YIN
,uarmitteci as: l _yl— ' v' "\
Under Section: I d
Supplementary regulations section:
Parking formula:
c
Required spaces:
Y 4N
Ite be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 11/l/2015 Page 3 of 3
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
Hahn Gustafson Catering, Inc.
is hereby granted a permit4icense by the Albemarle County Health Department to operate a
Caterer
Trading as:
HARVEST MOON CATERING
Located at:
3352 Berkmar Drive
Charlottesville, VA, 22901
Mailing Address:
3352 Berkmar Drive,
Charlottesville, VA, 22901
Conditions of Permit (if applicable);
Rapidly chill bulk food items to 41F using the approved 2 stage cooling process.
Date of Expiration
July 31, 2018
S. Myers, REHS
ental Health Supervisor
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
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