HomeMy WebLinkAboutSUB201800218 Application 2018-11-29•
APPLICATION FOR BOUNDARY LINE ADJUSTMENT PLAT
Owner/Applicant Must Read and Sign
The plat application process includes providing the County with all the information required in Chapter 14
Subdivision of Land of the Albemarle County Code.
The foregoing information is complete and correct to the best of my knowledge. I have read and understand the
provisions of Chapter 14 Subdivision of Land of the Albemarle County Code.
By signing this application I am consenting to written comments, letters and or notifications regarding this
application being provided to me or my designated contact via fax and or email. This consent does not preclude
such written communication from also being sent via first class mail.
/t�� /2 AVN
Signature of Owner, Contract Purchaser, Agent
G�N4� Q T
Print Name
1i --2-`j t'a
Date
`A3"-`t-77-o.-z6�
Daytime phone number of Signatory
FOR OFFICE USE NLY SUB # I ( 0Il Fee IIA,mount $ — Date Paid 1
By who? � Uk C7 `Receipt # I I CCA W Ck# (RoIN3.5 B J y:
/1/2015