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HomeMy WebLinkAboutCLE201800014 Application 2018-01-19Application for Zoning Clearance��A` 3 CLE#2-6/f 606W '' k �1RGIN�P OFFICE U O LY � / l PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: 6 J7&o m 1 -Z7o —oo — Co2p 0 _ Existing Zoning R/D :6 G jug 1K Parcel Owner: 5- S? 7 5-7" 77ey VA!547 JJ1e5 G L G 335 mevehfwT tv✓4J,� 'y' _ Z�Cs Parcel Address: S 6 40 HA�✓o s� City F"'OZbu'-� State Crrg- Zip 36--0 (include suite or floor) PRIMARY CONTACT /— Who should we call/write concerning this project? )5%01� 69"Mpy Address: 143/O P/ov City State V)Q- Zip ; 3i5639 Office Phone: (ee /b 33L1-075L Cell # Fax #60V 739 94 E-mail C©rn m eo'yVA elow- o=•., APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name --ltew business Business Name/Type: / 2z19 Previous Business on this site / 5+ C9ecy��xc? Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: 5j,W4 . 3 5r,t,-75 *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 1 own or have the owner's permission to use the space indicated on this application. I also certify that the infonnation provided is true and accurate to the best of my knowledge. 1 have read the conditions of approval, and I understand ahem,,. and that I will abide by them. Signature -%dc/5✓. Printed_ ��A✓',1> CJ�m�Y APPROVAL INFORMATION [ proved as proposed [ ] Approved with conditions [ ] Denied [ ckflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17. �], ,Bp [ L�'l�o 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 /L/ Zoning Official Date �f Other Official 9?t ft9fdJAl , Avk Y(, (A Date ij / 13� � County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised l 1/02/2015 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 it N ill 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 if is w If private well, provide Health epartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that apZbfic Is parcel on septic or sewer? ill, ;ill you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Yj/ N Will there be any new construction or renovations? If so, obt � r MPn i Permit # NC Zoning to complete the following: Reviewer to complete the following: Square footage of Use: 263Z Y/N ermittedas: Pu�tn�� eS�g61i5l�r��'� Under Section: Supplementary regulations section: b)(Iq Parking formula: resfiatv,01At LoUD_ 2 ItoSS oor QjgA Required spaces: Y N Ite be verified in the field: Inspector : Date: Notes: mv;} cull ply w i t�, �ea I{h Pf nortrP4 I e Uvl Oki u n,S Viola ns: Y/� If so, ist: Proffers: Y/N If so, List: Variance: Y/N If so, List: 'Lu S s• / If so --, List: Clearances: SDP's 1e17_Z Revised l I/1/2015 Page 3 of 3 oln" trs+vtw aorrroe7* Foodservice RECEIVE Environmental Health'ervices OCT 2 6 2017 Review CbophftraclAwa ffit 113aAM MU Drft C WdatrssWk Vd 22M P. a Bw 754s CJ+mf&U$VM4 V.4 2M Pkans: (�3IJ 97?-a2.lP A= (43q M-021 Show 1 emtaet ebt Fnitb Dapartmmt Whin a attr atablF _Mt OrTAM Cr tattanssat! 7be ffd* I gwun of bould ba me off — !?" 000eaoeed abmewr a a6ye adowaaahip a Sao da aa+r besim. Re ,umt pmmla n e ameMS&MW 7ba i'bxbraeltiad reatftoom6etmrwtat n%*Ik doa o ratetpimitspaalt Gaoe are IM eras be tined to the toed bm M" Waaft sham to iU I� t aoef bnetbtem >L a 0�16 � epmlos bsrpeat{am 4 tegatsed pion fa a permit to the sew earns: Ban tam eaa I opm 0w 1 nbait a'4baap of apy�ssttlaa! 7bo Imnaoe of a f ew pUMtt may Sttt ngsdre t ld� t morrsiem sad eft. II ismommmMU da orser aad peorpeedee b W enbmit tie paparroaic osrtiioed bow ad 66 arraa:e as msheWw u b ae MM Vq rtmmt to sa m If these ame apgsda to the or tbeft met VM ba reO A , pria'ta h2*E a aen pent ft 'I 3 � We" Wiest a aaderxm a obaaye of awsa iRt&eilib' Is On framed a a tmd sea 8ubegw2ft tba NEW mats ft meat =boom aompIitaae With dM moat maems r+estioa adtlw VMOolt Food Repntedamt belre a Moth am be Wood (pea the perlooe g amen l ebWa a asff of me nnut resins of the MWdfiFard xgx&asi M? A Iltnited aeasber of st ass a�bb•!br pp��hhww et ran b,>od baJtb d�tmaot omoe, oe you oaa visit Qia Vlr�Eala Deparomeat of Fleattb wabefte (aa�trdbrJrB{sfa.ta obtain ue9eebor>lavastfam. Building Permit p . Name of foodservice establishment: k' zzL Name of Owner: Type of Ownership: I xWdual_Corporadon� Facility Address:�35 /!1 ty►Zchr r W�1 K 5 S"; r�A� 1�—kaf=Tz r YoUAJ c j ►4-s /� Gh Fa►z I �+i�v; ll�. 1/'F} Z..�q oz _ ! 0 9lrsZ.. i�i chA+�3c�., Ra � T. ��1� V� �� Telephone Nambers:($by) -TSO- 30 9 R Contact Email Address: _U R&MgIe BAN..Gor+,&L,,,V _4 I&IM-erz a ► 1=r� �g.c�r, � Plana and Information Submitted By: Date: Anticipated opening date: Seating capacity _ !k 8s Type of Mena -Please check all that apply: Fiiilservicoy Fast Food Gourmet C=yout, Z Catereer School -Public or Private Daycare Group Home Grocery Store Institution Type Nursing home Hospital Hotel Continental Brea &A Mobile4 ush cart Seasonal Type Information to be submitted to Environmental Health Department: Menu Equhmumt numbered on floor plan drawn to scale Plan review application Pay plan review and annual permit fees Annual ps:mit application Equipment specification sheets and plumbing diagram Type of Water Supply: 6i�ior Private Noncommnmity? YES NO Approved Approval Date: Type of Sewage System: D tibte Approved: 0 YES ONO 0 Private Approved: 0 YES 0 NO Date: Environmental Health rov enial: Approved by: Qj 11 a, � I Date: "I S 13 i ri I m Is h 11 , I Ill I d 1151;'! i ]Sig Gy" I come 1111118 WO-9008088001 HIS no un Ill Iloilo no pill!! gERRETZ EXTREME PIZZA I T f C T 5 5TH STREET CENTER, SUITE 200 (D YOUNG CHARLOTTE5\/ILLF VA