HomeMy WebLinkAboutCLE201500007 Legacy Document 2015-01-27Application for Zoning Clearance'
CLE # D),C3 - 7
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # 201 °( Date: I 12.
Receipt # Q ) Staff: Die
PARCEL INFORMATION
Tax Map and Parcel: 03200-00-00-03800 Existing Zoning C1 Commercial
Parcel Owner: Hansen Airport Plaza LLC
Parcel Address: 3510 Seminole Trail, Ste. 3506 City Charlottesville State VA Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? David Goloversic
Address: 39 John Boulevard City Ruckersville State VA Zip 22911
Office Phone: (434) 409-6177 Cell # (434) 409-6177 Fax # E-mail info@logoschurchva.org
APPLICANT INFORMATION
Check any that apply: Change of ownership ° Change of use Change of name X New business
Business Name/Type: Logos Church, Inc./ church with a "for-profit" arm
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:
Use as a church as well as administrative and professional offices for its "for-profit" arm. Larger church events get
coordinated during the "off hours" of the neighboring businesses. Approximately 35 parking spaces on property.
*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 U1?_M' zlLnat.�rinted David Goloversic, President of Logos Church Inc.
APPROVAL INFORMATION
IjQ 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 ] / z j (S
Zoning Official Date /127ZLc5
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 7/1/2011 Page 2 of 3
Intake to complete the following:
YJinIs LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wiilthere 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:wa:terIf private well, provide Health ement 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 ublic s er?
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:I^
(DI N �l
Permitted as: —/
'f u ✓ LL� c y
Under Section: --Z--2-
Supplementary
2
Supplementary regulations section:
Parking formula: t
/�,M-9
P, MCC -
Required spaces:
Y/6)
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/19
If so, List:
Proffers:
Y/
If so, ist:
Variance:
Y/t
If so"ist:
/N
f so, List:
Clearances:
SDP's
Revised 7/1/2011 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 Hansen Airport Plaza LLC the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number 03200-00-00-03800
manner identified below:
by delivering a copy of the application in the
X Hand delivering a copy of the application to Real Property Inc. c/o Kim Norford
[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 January 12, 2015
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 Applicant
David Goloversic, 9fe-si gilf 0 -P zogos Chvnrk Zr,
Print Applicant Name
January 12, 2015
Date
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