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HomeMy WebLinkAboutSUB200900082 Application 2009-05-26 Appli aiion for Review of 746, Boundary Line Adjustment & Easement Plats © ' ❑ Boundary Line Adjustment=$95 Easement=$95 • (3 folded copies of plat) (3 folded copies of plat) ❑ Groundwater Assessment (Required if a less than 21 acre lot is created from a 21 acre or greater lot) $250+$25 per new lot of less than 21 acre= Project Name: ,t 4 c_ �7`p- Tax map and parcel:77 / 33- I Dc/4' Ti,32- SC Magisterial District:l UCfhrl\ Zoning: ! 7�✓ Physical Street Address(if assigned): 23 0h! Fj5 Rd 141� Location of property(landmarks,intersections,or other): Z 1 /4d1-T 14 �' 6 d((��zs R dA1 Contact Person(Who should we call/write concerning this project?): C. 3 T C t)-47 1 T Address 3042.- D 13EI 1t W AK- U>Z City CA-1 '4I�ii) l LA.,l2 ,/J.K--l� VSttatee V Y-'1'et Zip Z Z 90 I Daytime Phone 434 611 0 13 Fax#(43 )t ')300 20- E-mail - Cl J rn Owner of Record JJ$X T C--� B12►4 o'4 L (_ C- / y� / l/,q Address )at5) �5 ? ✓City_ C�'arfO/Eb'U��C 5E� State V/ / Zipe7C_�' Daytime Phone 3 �I'7h 3371E Fax#( h/5'O 67 E-mail Applicant(Who is the Contact person representing?): ,L/E T G'-E4 Ei )0.Tt 0^j /5—Age- , 80U1T Address City (( State Zip Daytime Phone( ) Fax#( ) E-mail Owner/Applicant Must Read and Sign The plat application process includes providing 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. 5-19 -0 9 Signature of Owner, Contract Purchaser,Agent Date C 5TF_�lt r2�2ET-r -43 4- "1 3 - c7 c13 Print Name Daytime phone number of Signatory FOR OFFICE USE ONLY SUB# Fee Amount$J 5,bn Date Paid Q( By who? O11,i VeCS (& - Receipt# 75/1! Ck# 1 2 v� By: VT'S County of Albemarle Department of Community Development 401 McIntire Road Charlottesville,VA 22902 Voice: (434)296-5832 Fax: (434)972-4126 11//19/07 Page 1 of 1