HomeMy WebLinkAboutSP202100013 Application 2021-06-15Application for
Special Use Permit
VIE11 1
IMPORTANT: Your application will be considered INCOMPLETE until all of the required attachments listed on page 2 1
have been submitted with the appropriate signature on page 3. Also, please see the list on page 4 for the appropriate fee(s)
related to your application.
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PROJECT NAME: L 1 �.N 98 -W,
(how should we refer to this application?) d
PROPOSAL/REQUEST:ok�
ZONING ORDINANCE SECTION(S): 10. 2— o Z ZO
EXISTING COMP PLAN LAND USE/DENSITY: R 16 s
LOCATION/ADDRESS OF PROPERTY FOR SPECIAL USE PERMIT:
1.-• #- M 1 '7 e-o - Ac ro s S -Pr- . 12- 4 S `fro wr Cre .lc lej 2- 2— 10.3
.
TAX MAP PARCEL(s): 086 d 0— 0 U- 00 - U 1-7 CD
ZONING DISTRICT: �► 1It��d l�d S
# OF ACRES TO BE COVERED BY SPECIAL USE PERMIT if a portion, it must be delineated on a plat): R crE 6
Is this an amendment to an existing Special Use Permit? If Yes provide that SP Number. SP-
❑ YES EN/O
Are you submitting a preliminary site plan with this application?
❑ YES [9'NO
Contact Person (Who should we call/write concerning this project?): A kArvr. -14b4 �" \ do /
Address 10 l go e_ky1 13, floxi w City A-N o ,J State JM � zip 24 Zc7
Daytime Phone(`� IIft - OS 95 Fax # ( )r/st E-mail h Lk L I Vi m 4 £o. (' t x , QO/
Owner of Record _.ram Sr A e is C An AAM11 L
a L e
Address 2 10 O d{7� re) V ec-.r L poesy /r City I� o r 4 6 Aref y J State V`Z-ip 2_. z fi-I
Daytime Phone (7 3 � L lS 7 090 Fax # L� E-mail 5�e✓ e �rcl/ �Y.�J�
Applicant (Who is the ContactL.person repreessenting?): t V t�� r ,Cc
L
J
Address b t s o jec y 94m LA Ala City A State _V_A Zip L.2 / 2 a
Daytime Phone (Y-?Y ?JI-651S Fax # L_) E-mail '/ „ COM
/
Does the owner of this property own (or have any ownership interest in) any abutting property? If yes, please list those tax to and parcel numbers:`
FOR OFFICE USE ONLY SP #
Fee Amounts Date Paid By who?
ZONING ORDINANCE
Concurrent review of Site Development Plan? YES_ NO
Receipt #
By:
County of Albemarle
Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Special Use Permit Application Revised 2/28/2019 Page I or
APPLICATION SIGNATURE PAGE
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 5)
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 written communication from also being
sent via first class mail.
P&V2 Y
Signature of Owner / Agent / Contract Purchaser
. Ract.vvL. k-4 D4+
Print Name
411 2.0Zi
Date
H 3L-qS I - OS�S
Daytime phone number of Signatory
Special Use Permit Application Revised 2/28/2019 Page 3 or 3
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, L ; v; V 6At'4-R 6"(
[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 OS C, 00 — ern - on - o 1 -7 Cy
by delivering a copy of the application in the manner identified below:
Hand delivery of a copy of the application to eve kap
on /i A/r Z/
Date
= Mailing a copy of the application to
Date
to the following address
[Name of the record owner if the recor 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]
[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]
[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].
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Sign`a r7off p�plicant
y / Ti(/ f -
Print Applicant Name
Date
(//5loti/
Special Use Permit Application Revised 2/28/2019 Page 5 of 5