HomeMy WebLinkAboutCLE201700050 Action Letter 2017-10-13APPROVED
b� the Albemarle County
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Application i r Zoning -Clearance
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FRLE #
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PLEASE REVIEW ALL 3 SHEETS
OFFICE US ONLY
Check # Date: o?
Receipt # Staff: JV
PARCEL INFORMATION
Tax Map and Parcel• 05G �� - pi - 00 - 0-5 70'-) Existing Zoning
Parcel Owner: JU i A 2
Parcel Address: 12-6l) C oz,6-- Ave City CkGState V c�,- Zip
(include suite or floor)
PRIMARY CONTACT i
Who should we call/write concerning this re—t
project?7-7(75K
Address: �b f3y- c 1 C00—R- �y Q ZipaD,
1 City State
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Office Phone: ' Fax # E-mail 610/ s,1Lyj e
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: 1151 S-D D 6v-, [ I
Previous Business on this site_ La r-C)YICt nC& DeI G C'
Describe the proposed business including use, number of employees, number of shifts, available parking aces, number of
vehicles, and any additional information that you can provide: ifeG-
*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 accujatle to the best of my knowledge. I have read the conditions of approva and I understand them, and that I will abide b�y them.
LSRLMSignature Printed
APPROVAL 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.
Notes
Building Official Date
Zoning Official Date '?
Other Official sa hers M, (� ` Date
%-.uunry of Aioemarte liepartment of Uommunity Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
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Revised 11/1/2015 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.
N
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 o ublic wa er?
If private well, provide Health in form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appl
Is parcel on septic or p lie sewer.
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 #
f,oning to complete the iollowin :
Viol ons:
Y /
If so, List:
Varia ce:
Y /1
If so, List:
Clearances:
Reviewer to complete the following:
Square footage of Use: V
() / N
Permitted as: AA
Under Section: 2J r
Supplementary regulations section:
Parking formula: .f
Required spaces:
Y/
Items to be verified in the field:
Inspector:
Notes:
Date:
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
Snead, Cornelia
is hereby granted a permit/license by the Albemarle County Health Department to operate a
Full Service Restaurant
Trading as:
WHISTLE STOP GRILL
Located at:
1200 Crozet Avenue
Crozet, VA, 22932
Mailing Address:
PO BOX 914,
Crozet, VA, 22932
Conditions of Permit (if applicable);
Date of Expiration
September 30, 2018
Environmental Health Specialist
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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