HomeMy WebLinkAboutSE202100048 Application 2021-12-03•
APPLICATION FOR A SPECIAL EXCEPTION
® Request for a waiver, modification, variation or ❑ Variation to a previously approved Planned
substitution permitted by Chapter 18 Development rezoning application plan or
Code of Development
OR
❑ Relief from a condition of approval
Provide the following
1 copy of a written request specifying the
section or sections being requested to be
waived, modified, varied or substituted, and
Provide the following
1 copy 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.
any other exhibit documents stating the reasons 1 copy of a written request specifying the
for the request and addressing the applicable provision of the plan, code or standard for
findings of the section authorized to be waived, which the variation is sought, and state the
modified, varied or substituted. reason for the requested variation.
FEE = 523.12
Application $503 + Technology surcharge $20.12
Project Name : Wawa - 1215 Seminole Trail
Current Assigned Application Number (HS, HO, CLE, SDP, SP or ZMA)SDP202100073
Tax map and parcel(s): 061w0-02-oA-00100
Applicant / Contact Person Carter Baum
Address 1700 Willow Lawn Drive, Suite 200 City Richmond State VA Zip 23230
Daytime Phone# (8o4 ) 273-8374 Fax# (
Owner of Record
Address
Daytime Phone# (
Fax# (
City
Email caner.baum@kimley-horn.com
Email
State _ Zip
County of Albemarle
Community Development Department
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2021
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APPLICATION FOR A SPECIAL EXCEPTION
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 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 written co munication from also being sent via first class mail.
Sigma re Owner Agent / Contract Purchaser Date
Print Name
FOR OFFICE USE ONLY APPLICATION#
By who?
Receipt #
8-
Daytime phone number of Signatory
Fee Amount $ Date Paid
Ck#
Revised 7 1 2021
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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.
1 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:
aHand 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 recipient's title or office for that entity]
on
Date
F—IMailing 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 recipient's title or office for that entity]
on
Date
to the following address
[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 sa isfies this
requirement .
Signatu ppl cant
Print Applicant Name
Date
// /, 7
Revised 7/12021