HomeMy WebLinkAboutCLE201600207 Application 2016-09-16rZoning Clearance
Application for
is
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CLE # o� LP OW04
OFFICE USE ONLY
50-- Date: 1311 LP
PLEASE REVIEW ALL 3 SHEETS
Check#
Receipt # Staff: 35
PARCEL INFORMATION
Tax Map and Parcel: 04500-00-00-10900 Existing Zoning
Parcel Owner: RIVANNA PLAZA SPE LLC
ParcelAddress:325 Rivanna Plaza Drive City CHARLOTTESVILLE State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Rob Jacknewitz
Address: 2324 Hampton Ave City St. Louis State MO Zip 63139
Office Phone: 3( 14) 647-5100 Cell # Fax # 314-646-0262 E-mail robjacknewitz@gmail.com
APPLICANT INFORMATION
Check any that apply: X Change of ownership Change of use X Change of name New business
Business Name/Type: Mattress Firm / retail mattress sales
Previous Business on this site Sleepy's 1 retail mattress sales
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:
*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 ermission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowledg . I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Robert Jacknewitz
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, 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 DA Date Cy l t;
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
Revised 11/02/2015 Page 2 of 3
Intake to complete the following:
Y/O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y1
Will Itere 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 p �ic�wr?
If private well, provide Health nt form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that app4
Is parcel on septic o ublic sewe .
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:
0 / N
Permitted as:
Under Section: y '
Supplementary regulations section:
Parking formula: /
Required spaces: Z3
YIN
Items to be verified in the field:
Inspector
Notes:
Date:
Violations:
Y/(N)
If so�(st:
Proff rs:
Y/(�
If so, List:
Varian e:
Y/
Ifs , ist:
/N
If so, List:
a7
Clearances:
SDP's
Revised 11/l/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,
[County application name and number]
was provided to RIVANNA PLAZA SPE LLC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 04500-00-00-10900
manner identified below:
Q 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
0 Mailing a copy of the application to RIVANNA PLAZA SPE LLC
[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 9-12-2016
Date
to the following address:
1208 PRESTON AVE CHARLOTTESVILLE VA, 22903
[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].
O:Q�
Signature of App%cWnt
Robert Jacknewitz
Print Applicant Name
9-12-2016
Date
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