HomeMy WebLinkAboutCLE201800021 Approval - County 2018-04-20Application for Zoninff Clearance
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OFFICE USE ONLY
PLEASE REVIENV ALL 3 SHEETS
Check # C1 Date: 2
Receipt # 1Staff:
PARCEL INFORMATION
Tax Map and Parcel• • D f 1 ' 032 ft Existing Zoning I�
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Parcel Owner: llk�A&%/ VCU5-4-
Parcel Address: Z�� 1�;5 k 64. I Ipite City ' G II State V A- !_ip z'�
(include suite or llo r- ' -
PRIMARY CONTACT
Who ii e call/write this
should concerning project?
Address: 11411� 4;11Lju C<C( !(J . City State Jf� Zili��Z�
Office Phone: Cell #W- Fax # E-mail 40-4+64 SD JC�►n.� �; o."
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use _Change of name Ii New business
Business Name/Type: A 6-(6_ &. LI c e w4y (dtlfZ 410
(A& cif v/4 0
V" o C DV4 t ,L�
Previous Business this &Jy (t E
on site k 41
Describe the proposed business including use, number of employees, number of hifts, available arking spaces, number of
vehicles, an an), additional information th you can prpvide:
�t
jl�A, 1 ( / )
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This Clearance ,ill my he valid on the parcel for which it is approved. if you change; intensify or move &e use to ew 16cation, a new Zoning
Clearance will be required.
1 hereby certify that I own or have the ow is permission to use the space indicated on this application. 1 also certify that the information provided
is true and a t the best o y kn pledge. 1 have read the conditions of approval, and 1 understand them; and that I will abide by them.
Signature r Printed
APPROVAL INFORMATION
[VIas Approved Denied
roved proposed [ ] with conditions [ ]
[kflow prevention device and/or cut -rent test data needed for this site. Contact ACSA, 977-4511, xl 17.
[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 �fz Date Z�
Other official_ N� � 1�>♦t—gjjotChd Date 4,ZQ/1
County of Alhemai-le Department of Community Development
401 Mcintire Road Charlottesville. VA 22902 Voice: (434) 296-S832 Fax: (434) 972-4126
PC%iced 11 '02 201 `Page 3 of 3
Intake to complete the following:
Y 21�
]s H1 or PD]P zoning'? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
Will 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 or ublic water
If private Nvell, provide Heal epnwlnwnt form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applie
Is parcel on septic or ublic sewer.
Y/N
Will you be putting up a new sign of any kind? if so, obtain proper
Sign pennit.
Pet-mit# will 14ulle SeQr(�Ae perm��
), / N
Will there be any new construction or renovations?
If so, obtain the proper Pennit.
Permit #
rYe y u�t 2b S Q
B 1uig -S51 Ac,
Zoning to complete the fol
Viol s:
If IN
Ifs tst:
nce:
List:
l°1�3-10
t A3z S,0
1kRI LA3
Clearances:
`� o ►b = Lam, -Z_�___f ys
LUI4 —
2e l l — 13S -
- wos- 6
Reviewer to complete the follovN,ing:
Square footage of Use
Priittedas: food` ttltQt 11dI,b, S eclgl} _Ts
Under Section:
Supplementary regulations section:
Parking fornnula:
t�200. 9iGl.
V
Required spaces:
Y/N
lie be verified in the field:
Inspector:
Notes:
Pro s:
Y/N
if. _ist:
SP'
Y/N
If st:
SDP's
Date:
Revised 1 1: ] 201 ` Pafe � "f 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
Link, Scott
is hereby granted a permiblicense by the Albemarle County Health Department to operate a
Carry Out Food Service Only
Trading as:
ROCKET COFFEE
Located at:
5688 Rockfish Gap Turnpike
Charlottesville, VA, 22903
Mailing Address:
5688 Rockfish Gap Turnpike,
Charlottesville, VA, 22903
Conditions of Permit (if applicable);
Date of Expiration
April30, 2019
Environmental
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
1138 Rose Hill Drive
Charlottesville VA 22903
(434) 972-6219