HomeMy WebLinkAboutSE202000009 Application 2020-08-06•
•
P APPLICATION FOR A SPECIAL EXCEPTION
❑ Request for a waiver, modification, variation ❑ Variation to a previously approved Planned
or substitution permitted by Chapter 18 = $457 Development rezoning application plan or
Code of Development = $457
OR
❑ Relief from a condition of approval = $457
Provide the following
❑ 3 copies of a written request specifying the
section or sections being requested to be
waived, modified, varied or substituted, and
any other exhibit documents stating the
reasons for the request and addressing the
applicable findings of the section authorized
to be waived, modified, varied or substituted.
Project Name :
Current Assigned Application Number (SDP, SP or
Tax map and parcel(s):
Applicant / Contact Person
Address
Daytime Phone# ( ) Fax#
Owner of Record
Address
Daytime Phone# (
Fax# (
City
City
Provide the following
❑ 3 copies of the existing approved plan
illustrating the area where the change is
requested or the applicable section(s) or
the Code of Development. Provide a
graphic representation of the requested
change.
❑ 1 copy of a written request specifying the
provision of the plan, code or standard for
which the variation is sought, and state the
reason for the requested variation.
Email
Email
State Zip
State Zip
County of Albemarle
Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
APPLICATION FOR A *PECIAL OCCepTION
If the person signing the application is someone other than the owner of record, then a signed copy of the
"CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE
LANDOWNER" form must be provided in addition to the signing the application below. (page 3)
Owner/Applicant Must Read and Sign
By signing this application, I hereby certify that I own the subject property, or have the legal power to act
on behalf of the owner of the subject parcel(s) listed in County Records. I also certify that the information
provided on this application and accompanying information is accurate, true, and correct to the best of my
knowledge. 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 wri communication from also being sent via first class mail.
Signature of Owner / Agent / Contract Purchaser Date
�Or it e. 0 /K O S a�w f s Jci
Print Name
FOR OFFICE USE ONLY APPLICATION#
By W"? Receipt #
C qg h ZN4 -S;17r-
Daytime phone number of Signatory
Fee Amount $ Date Paid
C4#
By_�
0111: N■"/•
APPLICATION FOR A SPECIAL EXCEPTION
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany this zoning application if the application is not signed by the owner of the property.
I certify that notice of the application for,
[Name of the application type & if known the assigned application #]
was provided to
[Name(s) of the record owners of the parcel]
the owner of record of Tax Map and Parcel Number
by delivering a copy of the application in the manner identified below:
on
Hand delivery of 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 recipients title or office for that entity]
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 recipients title or office for that entity]
on to the following address
Date
[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
Print Applicant Name
Date