HomeMy WebLinkAboutACSA202200002 Application 2022-03-23Application to
Amend the Service
Jurisdictional Area
❑ Amend the Service Authority Jurisdictional Area = $135.20 ($130.00 + $5.20 Technology Surcharge)
Project Name: Firdyiwek-Deal Rezoning
Tax map and parcel: TMP 90-3A
Physical Street Address (if assigned): 954 Old Lynchburg Rd.
Location of property (landmarks, intersections, or other):
Magisterial District: Samuel Miller
Contact Person (Who should we call/write concerning this project?): Yitna Firdyiwek
Address 954 Old Lynchburg Rd. City Charlottesville
Daytime Phone C—) (434) 825 4209 Fax # C__)
ONoner of Record Yitna Firdyiwek & Sharon Deal
Rural Areas
State Virginia zip 22903
E-mail yfirdyiwek@gmail.com
Address 954 Old Lynchburg Rd. City Charlottesville
Daytime Phone C_) (434) 825 4209 Fax # (___)
Applicant (Who is the Contact person representing?): Yitna Firdyiwek & Sharon Deal
State Virginia zip 22903
E-mail yfirdyiwek@gmail.com
Address 954 Old Lynchburg Rd. City Charlottesville
Daytime Phone ( (434) 825 4209 Fax #
State Virginia zip 22903
E-mail yfirdyiwek@gmail.com
FOR OFFICE USE ONLY TMP #
Fee Amount $ Date Paid By who? Receipt # Ck# By:
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2021 Page 1 of
Jurisdiction area designation requested
0 Water and Sewer
❑Water Only to existing structure(s)
❑ Water Only
❑Limited Service (Describe in justification below)
Current Service Area Designation
❑ No designation
❑ Water and Sewer
❑ Water Only to existing structure(s)
0 Water Only
❑ Limited Service (Please describe _
Justification for request:
R-2.
property is within the Development Area and the proposed rezoning is to change the zoning of the property from RA to
Owner/Applicant Must Read and Sign
I hereby certify that the information provided on this application and accompanying information is accurate, true
and correct to the best of my knowledge and belief.
03/15/2022
Signature of Owner, Contract Purchaser, Agent Date
Yitna Firdyiwek (434) 825 4209
Print Name Daytime phone number of Signatory
Revised 7/1/2021 Page 2 of 2