HomeMy WebLinkAboutCLE201800109 Approval - County 2018-07-24Application fo �.ZoniN CLE C earance
PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONL
Check # to A I IDate: Gl
Receipt # Staff:
PARCEL INFORMATIONf�
/
Tax Map and Parcel:l_M, V ' NN• b 1 - brA C.D Existing Zoning I/(
Parcel Owner:q
Parcel Address: 3 d 0�h- Q'J, Dr-N� City w; Its State Uif Zip '
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? �h
Address Lc. may, Cj'-) ._ City Edfcsf- State ��) Zip arts
Office Phone: Cell # 2,K6 -71-7 7 Fax # --- E-mail �n�LGas�.,m lr► 33rr�3t
1i
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name _X_New
business
fr
Business Name/Type �f7�D �e;s /h acd �� Cat, f�- / Ka3� �/ /z� i' / L&
Previous Business on this site
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: �ys�t �; . �1— 15�2 6 PraO�j� y�c3 Z S (n
*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 information provided
is true and accurate to the best of my dge. 1 ave read the conditions of approval, and I understand them, and that I will abide by them.
Signature . z_ Printed
APPROVAL INF RMATION
[ ] Approved as proposed ( ] Approved with conditions [ ) Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, 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 k`L 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
la
i/I
Revised 11/1/2015 Page 2 of
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.
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 public water?
If private well, provide 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 septic or public 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 #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to 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 11/1/2015 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
was provided to
[County application name and number]
[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
Mailing a copy of the application to
[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
to the following address:
[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].
l
Signature of Ap ca t
Print Applicant Name
Date
Application forZoni, C earance
CLE # Z% '{�C/
y T
OFFICE USE ONL
PLEASE REVIEW ALL 3 SHEETS
Check # Date: i
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel:' DO - 6h. bib. bnq C p Existing ZoningH (G yIlC( crM 6w(
Parcel Owner: —rrL C_ +mot
i
Parcel Address: q O 0ih-► ', Pr le- City State t_j Zip
(include suite or floor)
PRIMARY CONTACT
^-�--
Who should we call/write concerning this project? J�„n ��►�
Address f*L-7 City EGGS r- State / Zip ass
Office Phone: Cell # 2 f(6 -2 1 -7 "_ Fax # — E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name _New business
Business Name/Type:
Previous Business on this site
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: a }tu{- )S�Z O �p�i`t�e3 7- S G�
*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 information provided
is true and accurate to the best of my dge�. I ave read the conditions of approval, and I understand them, and that I will abide by them.
Signature H
Printed ova Q1'�n � h
__:�:F
APPROVAL INRMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 I, x117.
[ ] 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�L/ Date 71l
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
la
M
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.
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 public water?
If private well, provide 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 septic or public 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 #
Zoning to complete the followint?:
Reviewer to complete the following:
Square footage of Use:
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to 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 I I/1/2015 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
was provided to
[County application name and number]
the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
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
Mailing a copy of the application to
[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
to the following address:
[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 A;40caht
r kA
Print Applicant Name
Date
_ ..���; c4,1 Ci e..
Do,r
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
Cash Enterprises Roanoke
is hereby granted a permit/license by the Albemarle County Health Department to operate a
Full Service Restaurant
Trading as:
TROPICAL SMOOTHIE CAFE
Located at:
930 Olympia Drive
Charlottesville, VA, 22911
Mailing Address:
1710 LeJack Circle,
Forest, VA, 24551
Conditions of Permit (if applicable);
Date of Expiration
July 31, 2019
M. Reed Cranford, R S, CP-FS
Environmental Healfff 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
1138 Rose Hill Drive
Charlottesville VA 22903
(434) 972-6219