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APPLICATION FOR RURAL SUBDIVISION
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 communic 'on from also being sent via first class mail.
March 16, 2017
Signature of Owner, Contrac Purchaser, Agent Date
Gwen
Print Name
434) 293-3195
Daytime phone number of Signatory
FOR OFFICE USE ONLY, SUB # - Fee Amount $ ��� Date Paid _
By who? '0 C ` _S (14-0 Receipt #