HomeMy WebLinkAboutSUB202200053 Application 2022-03-23 Page 1 COUNTY OF ALBEMARLE
APPLICATION FOR EASEMENT PLAT
Easement plat(s) without a deed = $603.20 $580+23.20 Technology surcharge
Easement plat(s) with a deed = $934.96 $899+$35.96 Technology surcharge
Easement plat(s) required with a site plan = $246.48 $237+$9.48 Technology surcharge
Easement plat(s) amending a previously approved easement plat(s) = $246.48 $237+$9.48
Technology surcharge
(Provide 5 copies of plat)
Project Name r-</.4Wt/4- r, /z.A 4-,--)6'J/L/zrk.
Tax map and parcels 66/WC o Z e:',9 GYJ/O ) 66/G.J v 0 Z vv oo ZaO
Zoning G j
Physical Street Address(if assigned):
Applicant /Y1A,,,. ti774./..c.3 /pejv4146 Co/JSUG7r,JCa
Street Address e'6 D 5 /..v6'S 7"a✓v v/J C6 r.t 7' .. /.12,Lien SU/ 7/4)
City /,/r ,.env State 07 Zip Code ZZ/f.?.
Phone Number 7/- 7vl3"-- ciY 3 6
Email n7`O J'.¢/.✓a"—@ IZ(.0 .)4t / COdIJ.SUL>/.U,e,, J "7'
Owner of Record Gh'rgr4.v 77CS(//L�-�` �G ��1./ rG`N,e- M4'm4J
Street Address
City State Zip Code
Phone Number
Email
Contact (who should we contact about this project): . ei I7 4471��/=- �C ?�1�S7" z)ase+�f
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Street Address /4/6'0 4/'4Z-P S /ram
City G /4'1- �'�J State 1// Zip Code 2 3ca o
Phone Number �'!� �- SyS- 2 38'
Email //4 Ltd i/Lex/ 22 S, C-1/4 Cam'''
County of Albemarle
Department of Community Development
401 McIntire Road Charlottesville,VA 22902 Voice: (434) 296-5832 Fax: (434)972-4126
I ;lip
JO 's'11110
Page 2 COUNTY OF ALBEMARLE
APPLICATION FOR EASEMENT PLAT
Owner/Applicant Must Read and Sign
The plat application process includes providing the County with all the information required in Chapter 14
Subdivision of Land of the Albemarle County Code.
The foregoing information is complete and correct to the best of my knowledge. I have read and understand the
provisions of Chapter 14 Subdivision of Land of the Albemarle County Code.
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.
3 -/S- 2a.
Signature of O r, Contract Purchaser,Agent Date
/< A1*2, ,ei/0,.
Print Name Daytime phone number of Signatory
Sec. 14-208.2 Easement plats.
The following sections shall apply to each easement plat, when applicable:
A. General: Sections 14-100 through 14-108.
FOR OFFICE USE ONLY SUB# Fee Amount$ Date Paid
By who? Receipt# Ck# By: