HomeMy WebLinkAboutSE202200006 Application 2022-01-15•
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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
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.
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.
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.
FEE = 523.12
Application $503 + Technology surcharge $20.12
Project Name :
Green Hill Cottage
Current Assigned Application Number (HS, HO, CLE, SDP, SP or ZMA) #HS202100045
Tax map and parcel(s):
Applicant / Contact Person Tulku Kalsang Gyatso
Address 8270 Green Hill Ln
Daytime Phone# (
Owner of Record
540) 836-8461 Fax#(
City
Tulku Kalsang Gyatso
Address 8270 Green Hill Ln
Daytime Phone# ( 540-$36-8461 Fax# (
City
Greenwood
State VA Zip 22943
Email Gyatso80@gmaii.com
Greenwood
State VA Zip 22943
Email Gyatso80@gmaii.com
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 communication from also being sent via first class mail.
Signature of Owner / Agent / Contract Purchaser
Tulku Kalsang Gyatso
Print Name
FOR OFFICE USE ONLY APPLICATION#
By who?
Receipt #
01 /10/2022
540-836-8461
Daytime phone number of Signatory
Fee Amount S Date Paid
Ck#
By.
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 app&cation 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:
Hand delivery of a copy of the application to
on
Date
on
[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]
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]
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 satisfies this
requirement].
Signature of Applicant
Print Applicant Name
Date
Revised 7/1/2021