HomeMy WebLinkAboutSP202200003 Application 2022-02-21,Lpplication for
Special Use Permit
IMPORTANT: Your application will be considered INCOMPLETE until all of the required attachments listed on page 2
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.
/
PROJECT NAME: (how should we refer to this application?) _'t�rii4�_QfeGritxt
PROPOSALIREQUEST: �1 Ck.14. x Qtr-SCICol
ZONING ORDINANCESECTION(S): t7�f 'Xs- e t GWI&C0.rC_rpr n cep 42CLG"4
EXISTING COMP PLAN LAND USE/DENSITY: Rttraal Ar2AS
LOCATION/ADDRESS OF PROPERTY FOR SPECIAL USE PERMIT:
42R 7 oici Threc Mo4-c1iRoaA S' 1, . n jte<y; llr,sj�, ZZgo 1
TAX MAP PARCFL(s): C)xj 20p - f)0- 00 - O 2_q A n
ZONING DISTRICT: VJ `V6 _lVe_ &Ak
# OF ACRES TO BE COVERED BY SPECIAL USE PERMIT (if a portion, it must he delineated on a plat): I Ctc(e
Is this an amendment to an existing Special Use Permit? If Yes provide that SP Number. SP- 201 Zo0008
❑ YES ❑ NO
Are you submitting a preliminary site plan with this application? IJd
❑ YES S-NO
Contact Person (Who should we call/write concerning this project?): Cl1 ZdbC-4h CI wear 1
Address 1--P� City Cro2e-+ State \kL_ Zip Z7_931-
Daytime Phone ( N Q Q b - $ 301 7 Fax # ( ) 0— E-mail dAA4 L'id O=
�t ,�
ton (coft
Ownerof Record MAt.ot.t.a .a P Ln,. 9%A ^4-.'R4-, r'L..rM,, n /^ AI A. -a. ,. 4- It 1, 1.....1
Daytime Phone (fA 82-3- 2 I :7:7 Fax # (_)
Applicant (Who is the Contact person representing?): E11'2Q 1x_+In C_' 1 ft r nil f)
Address 592 s' it9Cs+nr-% INN' City C.-/t,2G% State 4% Zip
Daytime Phone ) �6 - 19 3� -) Fax " (_) E mail nln. ,1 i I�T rr er�oo 1 [�J cKn
Does the owner of this property own (or have any ownership interest in) any abutting property? If yes, please list those tax map and parcel numbers:
FOR OFFICE USE ONLY SP #
Fee Amount $ Date Paid By who?
ZONING ORDINANCE
(ancurrent review of Site Development Plan? YES_ NO
Receipt #
By:
County of Albemarle
Community Development Department
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Special Use Permit Application Revised 7/1/2021 Page 1 of 5
APPLI 'ATION SIGNATURI 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.
Signature of Owner / A e t i Contr P rchaser
ParnP jd, D, d-.?oPP
Print Name
�&/ E
Date
Daytime phone number of Signatory
Special Use Permit Application Revised 7/1/2021 Page 3 of 5
The full list of fees can be found in Section 35 of the Albemarle County Zoning Ordinance.
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,
was provided to
of the application type & if known the assigned application #]
of the record owners of the parcel]
the owner of record of Tax Map and Parcel Number 5 7 - Z q,q
by delivering a copy of the application in the manner identified below:
on
Hand delivery of a copy of the application to
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 recipient's title or office
for that entity]
&2
[Name of the record owher 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 Ij T 2 to the following address S7 S 1. Ate l e (' .ram la-riP
Date
Cro �k, JCS Z2ci3 Z
[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].
S g atuApplicant
�[tZRt)t�wt (�(Qrrtnrt
Print Applicant Name
II/N
Dae
Special Use Permit Application Revised 7/1/2021 Page 5 of 5