HomeMy WebLinkAboutCLE201600208 Application 2016-09-16Application ford Zoning Clearance
CLE # X 16
OFFICE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # 153 Staff..
PARCEL INFORMATION
Tax Map and Parcel: QU 1(1y - Existing Zoning
Parcel Owner: RIO ROAD SHOPS LLC
Parcel Address:1650 RIO RD E 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 Mattress Discounters / 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:
Name Ghapga ko m- h4aness Disco, inters; o Mattress Firm, 2 amployeari, 1 rihift 10 9 M S, 12 6 9 1
*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 accurate to the best of my knowledge. 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 Date— 'L4 ( l fo
Zoning Official Date &IC /t6
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:
IsI
Is USLWLI, HI or PDTP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
YIN
Will er 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 CTUMlZwa r?
If private well, provide HeMtbPejwtfnent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic owublic se
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/0
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: 31
e)IN Permitted as: Le/VoL t o7, Aj�'
Under Section:
Supplementary regulations section:
Parking formula: /
I Ot,
Required spaces:
Y/N
Items to be verified in the field:
Inspector
Notes:
Date:
Viola 'ons:
Y/
Ifs , ist:
Proff s:
Y/l
If so, Est:
Variance:
Yl
If so, List:
SP's:
Yl�
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,
[County application name and number]
was provided to RIO ROAD SHOPS LLC
[name(s) of the record owners of the parcel]
and Parcel Number 06100-00-00-122A0
manner identified below:
Q 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
Q Mailing a copy of the application to RIO ROAD SHOPS 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:
2235 STAPLES MILL RD SUITE 202 RICHMOND VA, 23230
[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 Applicant
Robert Jacknewitz
Print Applicant Name
9-12-2016
Date
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