HomeMy WebLinkAboutSE202200025 Application 2022-05-04•
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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 $20.12
Project Name :
L13 T
Current Assigned Application Number (HS, HO, CLE, SDP, SP or ZMA)
Tax map and parcel(s):
Applicant / Contact Person IZushrrMQn A'1Glvf WS
Address 12-1 3 11 1rnezn Rd City C 1 V i l)e State ti l Zip 2-Z9Ol
Daytime Phone#(63D35113 Fax# ( ) Email (uSnrllCto 1$ INclq r4,1.Ld
�7 n ' ir7
Owner of Record ICL,1ShIVl(,r,/1 V�y'Y�,7�
Address ja )2�, t kmn o ELJQ City C' Vl State 1'4 Zip��J/
Daytime Phone# ($3'03S18 Fax# ( ) Email (21rW
(ushm4n C 5till- tOr�
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 / Kgent /Contract Purchaser
Print Name
FOR OFFICE USE ONLY APPLICATION#
By who?
S131ZZ
9/9- MI&P- 3s) S
Daytime phone number of Signatory
Fee Amount
Ck#
Date Paid
By_35
Revised 7/1/2021
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