HomeMy WebLinkAboutACSA199200005 Application 1992-05-28 APPLICATION TO AMEND THE ,<Aof ALitrr County of Albemarle
Department of Planning and Community Development
SERVICE AUTHORITY
;� 401 McIntire Road
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Charlottesville
JURISDICTIONAL AREAS '` 804 296-5823 'VA 22902-4596
APPLICANT Name: 3 e,,,,?//^ J��jjd����t ! - H- Vro b , Z�
Signature: % 7I`- �'-P0,--� Phone: 977 9'to 9 7
Address: 3 7 O-r'Kt�u��.c b r -l/e/
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CO-APPLICANT Name (or agent, if any):
Signature: Phone:
Address:
JURISDICTIONAL AREA DESIGNATION REQUESTED:
❑ Water and Sewer Water Only
O Water Only to Existing Structure(s) X Limited Service (Describe in Justification
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PROPERTY LOCATION (Address) /9-��✓� tha)v— Jed
Tax Map(s)/Parcel Number(s): fJ 4 — 9 — 4/
CURRENT SERVICE AREA DESIGNATION (If any):
O Water and Sewer 0 Water Only
tEr Water Only to Existing Structures 0 Limited Service
JUSTIFICATION FOR REQUEST: ` �,� , Ci/mi l .Gr/ar
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44t46 .S2-reci / �0 ;21-46%9t4--d.,4 q-rt#4/ R.1c. -77,44,perfieoZy trove
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For Staff Use Only
DATE SUBMII"I'hD: i/ I9c DATE$130 FEE PAID: 4 O? �/j'� ` / 5C)
PROPERTY IS LOCATED (Check Appropriate):
❑ Inside or 0 Outside a Growth Area? 0 Adjacent to SAJA?
❑ Inside or ❑Outside a Water-Supply Watershed? 0 Adjacent to a Growth Area?
Location and distance of water/sewer line proposed to provide service
REQUEST FOR AMENDMENT ADOPTED: 0 Yes 0 No Date of Action