HomeMy WebLinkAboutCLE201600241 Application 2016-10-21Application for Zoning Clearance
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OFFICE U ONLY
PLEASE REVIEW ALL 3 SHEETS Check # ��`17l Date: 141
Receipt # _, r)(0 L0 3 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 045CO-03-00-000BO Existing Zoning C1 Commercial
Parcel Owner: Todd Needham
Parcel Address: 920 Gardens Blvd., Suite 200 City Charlottesville State VA Zip 22901
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? David Goloversic, President of Logos Church Inc.
Address : 39 John Boulevard City Ruckersville State VA Zip 22968
Office Phone: (434) 409-6177 Cell # Fax # E-mail info@logoschurchva.or
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name X New business
Business Name/Type: Logos Church Inc.
Previous Business on this site NIA
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 permission to use the space indicated on this application. I also certify that the information provided
is true and acc to the bes f my knowledge. I have read the condditioq of approval, and I understand them, and that I will abide by them.
Signature4rdw W irnrrted 19 October 2016
APPROVAL INFORMATION
Approved as proposed [ ] Approved with conditions [ ] Denied
] Backilow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, 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:_ cO C_ e_ „ C.. •-� l'..,....: �g —S Q �p 1 A 9 « _ t o r Z�_A t 6
Building Official Date
Zoning Official '' Date/b
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:
Is rsin LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y l
WiII lere 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 w er?
If private well, provide Heahh ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE _
Circle the one that applie
Is parcel on septic o ublic se r?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
YIN
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: 4 a
Y/N
Permitted as: G U�
Under Section:
Supplementary regulations section:
Parking formula: /
Required spaces:
D
YT I
Items to be verified in the field:
Inspector • L, -
Notes:
Violatio s:
Yl
If so, List:
Proff.
ifN ist:
Vari
Yl
If so, List:
SP's:-
Y/1
If so, st:
Clearances:
SDP's
e)
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 !s not the
owner.
I certify that notice of the application,
[County application name and number]
was provided to Todd Needham
[name(s) of the record owners of the parcel]
and Parcel Number 045CO-03-00-000BO
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 Todd Needham
[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 19 October 2016
Date
to the following address:
788 Jefferson Drive, Palmyra, VA 22963
[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].
Si
a .Applicant
David Goloversic, President of Logos Church Inc
Print Applicant Name
19 October 2016
Date
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