HomeMy WebLinkAboutSE202200042 Application 2022-06-28APPLICATION 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 : Tiffin Farm
Current Assigned Application Number (HS, HO, CLE, SDP, SP or
Tax map and parcel(s): 02900-00-00-008H1
Applicant / Contact Person Michael Larsen
Address 1836 Tiffin Farm Lane
Daytime Phone# (949 ) 423-4165 Fax# (
Owner of Record Michael 8 Sarah Larsen
City Free Union State VA Zip 22940
Address 1836 Tiffin Farm Lane City Free Union
Daytime Phone# (949 ) 4234165 Fax# (
Email larsl836@gmaii.com
State VA Zip 22940
Email larsl836@gmaii.com
County of Albemarle
Community Development Department
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
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.
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Name
FOR OFFICE USE ONLY APPLICATION#
By who?
June 27, 2022
Date
(949) 423-4165 / (949) 274-2521
Daytime phone number of Signatory
Fee Amount S Date Paid
Receipt # Ck# By
Revised 7/1/2021