HomeMy WebLinkAboutSE202200028 Application 2022-05-05•
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APPLICATION FOR A SPECIAL EXCEPTION
Request for a waiver, modification, variation or
substitution permitted by Chapter 18
M'
❑ 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.
❑ Variation to a previously approved Planned
Development rezoning application plan or
Code of Development
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 reauPctPd H iatien
FEE = 523.12 F
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Application $503 + Technology surcharge $20.12 � 6L,++-c
Project Name : '�J n- 5 e f kn m Ste(-. , a
Current Assigned Application Number (HS, HO, CLE, SDP, SP or ZMA)�t weal - 0001 -�
Tax map and parcel(s): b O
Applicant / Contact Person -I,n �e-
Address 22?'(o �'-)Vc 'Nck� G2
City
State Zip
Daytime Phone# � ) &' lax# 5J-
Owner of Record I" 01` t"•, w LLC
Address City State ) f ' Zip 22
Daytime Phone#eEmail J) S M
r
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.
FOR OFFICE USE ONLY APPLICATION#
1; k I -2
Date
Daytime phone number of Signatory
Fee Amount $ Date Paid
By who? Receipt # Ck# By
Revised 7/1/2021
j
•
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 application 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 ,NLn, \,cA LL
owners of the parcel)
the owner of record of Tax Map and Parcel Number b (3 — 6s'.!;
by delivering a copy of the application in the manner identified below:
Hand delivery of a copy of the application to 75�-� 4� ^^ Q-0-0
[Name o the record owner if the record owner is a person; if
the owner of record is an entity, identify the recipient of the
� 2—record and the recipient's title or office for that entity]
o n S 2J'L
Date
EMailing a copy of the application to
o n S J-2- L
ate
[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]
to the following address '2t-(b a VY) 1-0 l ^O
[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
quirementl.
-Signature-of Applicant
G( . z awl, A,,,^C
Print Applicant Name
�I �+ 12 Z
Dat
Revised 7/1/2021