HomeMy WebLinkAboutSUB201300052 Application 2013-04-15 /� //�eI I ,�r�e Cou Community Development Department
'., Albemarle 401 McIntire Road Charlottesville, VA 22902 4596
t ' 13 Planning Application Voice : (434) 296 -5832 Fax : (434) 972 -4126
PARCEL / OWNER INFORMATION
TMPI 07800- 00- 00 -020M0 I Owner(s):
MARTHA JEFFERSON HOSPITAL
Application # SUB201300052
PROPERTY INFORMATION 1
Legal Description ACREAGE 11 MARTHA JEFFERSON HOSPITAL
Magisterial Dist. Rivanna Land Use Primary Commercial
Current AFD Not in A/F District Current Zoning Primary Planned Development Mixed Commercial
APPLICATION INFORMATION
Entered By
Street Address
Todd Shiflett
Application Type Subdivision Plat 104/15/2013
Project (Martha Jefferson Hospital - BLA
Received Date 04/11/1.3 Received Date Final I ( Submittal Date 04/15/13 Total Fees 200
Closing File Date Submittal Date Final Total Paid 200
Revision Number
Comments
Legal Ad
SUB APPLICATION(s)
Type Sub Applicati Comment
.. en 04 .15/ 13 : . .
Baunda . Line: d ustnn t / 1 1 � '.: ,.,... � . .........................uW...s
-.. w..,..._ W_ �W. W.,........_..,.,.,. WW_ WW.-. w„ W.. �.... W.. �.... W .............. LL........,.,..... vW..... �.. �. �W., �.. W....., W..,.,...,......... W�.....,..,.,.,.,.....,...,.,.,.,. W......,.,,..,.,...w.. �W.......... �.. w......................,... ..Ww......,......WW,,.. `
Owner /A#�plitant ; MARTHA- EFFERSON " TION
Address ( CityState I Zip Phone PhoneCell
APPLICANT / CONTACT INFORM
ContactType 1 Name
HOSPITAL: .P0 BOX 2606 'CHARLOTTESVILL 1
Primary Contact VALERIE LONG - WILLIAMS MULLEN 321 E. MAIN ST. #400 CHARLOTTESVILL 22902 4349515709
Applicant RON COTTRELL 500 MARTHA JEFFERSON DRI CHARLOTTESVILL 22911 4346547306
Signature of Contractor or Authorized Agent Date
Appl..ition for Review of 4
Boundary Line Adjustment, Easement Plat & Special Lots
�'/gGI;
7( Boundary Line Adjustment = $200 ❑ Easement plat(s) without a deed= $490 El Special Lot = $88
• (3 copies of plat) ❑ Easement plat(s) with a deed =$760 (3 copies of plat)
❑ Easement plat(s) required with a site plan =$200
❑ Easement plat(s) amending a previously approved easement plat(s) = $200
(3 copies of plat)
Project Name: 4 43 ' a TO
Tax map and parcel: ' ZOO 1, 70 G Magisterial District: 1 \� A n \UU Zonin Ply M O trit' D
Physical Street Address (if assigned): t oono T �5� Du( /' 11 t l (O Cc 'nr(� .
P Location of property (landmarks, intersections, or other): K k ,I'( {' PUNJu)cl i✓� C' j "r1U'
Contact Person (Who should we call/write concerning this project?): 1 ,(),\ Qe() W • WI WI O I (6r5, 1)
Address 37 ( f f' LOO City OW tSUWU State ue• (I ' `C� Zip ZL9 C' 7 /
Daytime Phone (\ J't) 151 5- 1 C Fax # (t x) 17 3(T) E -mail 'V'i� @ m (A MAO �1 ' 1
Owner of Record NAT, 7- rts,- \k(5 1 )10 J 7
Address " r n M 1t r (Xfv' ( Cit INKJV•��1 U State VI Zip l,C (
Daytime Phone ( ) Fax # ( ) E-mail
�7 n
Applicant (Who is the Contact person representing ?): �� W � 7r Qi ) t 65 Q 1 I (/V -((> 2',y Cotali
M me + 1,? City GAM f) Ue Zip �,L�11
Address �n �� � Ci � • p S tate `' `,,
Daytime Phone (43f ( -1'771 Fax # ( ) E -mail Coy \a� Etre,�l(� ('(1 tI •69-c
Owner /Applicant Must Read and Sign
The plat application process includes providing 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 ofChaptter 14 Subdivision of Land of the Albemarle County Code
'clod Ps 14
Signature of Owner, Contract Purchaser, Agen Date
Q0No GgOti 074) c n7 - Z-0
Print Name Daytime phone number of Signatory
FOR OFFICE USE ONLY SUB #
Fee Amount $ 3O' t/Jate Paid r I l f ' y who? I Y ' C t 6L () 3 Cldi S / V, : Jowl
County of Albemarle
Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
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