HomeMy WebLinkAboutACSA201100095 Application 1992-10-06 C T 0 6 1992
APPLICATION TO AMEND THE 4.&AQ34,4, County of Albemarle
Department of Planning and Community Development
SERVICE AUTHORITY t•--7 = 401 McIntire Road
1 Charlottesville,VA 22902-4596
JURISDICTIONAL AREAS 804 296-5823
APPLICANT Name: .j tc,6 W• ,1 1 — Y1 ••a Aeiiee..4,6 b�C l')' 79 Panel/9
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Pr'I• Signature: 3 a e- /88 f Ar•-_.�. Phone: -SS
Address: la 11=s YI71t Yo, 2z943 sod- J82-5 o 3 yV
GiO 0,
CO-APPLIC ame (or agent,i ,any): jhoil oca &)m 7?Y)73 flircr i8
No L Signature: /, Phone: -234 - 6399 9 OV
Address:
e / Zo 22503
JURISDICTIONAL AREA DESIGNATION REQUESTED:
❑ Water and Sewer 0. Water Only
❑ Water Only to Existing Structure(s) 0 Limited Service (Describe in Justification
below)
PROPERTY LOCATION (Address) c2� /
Tax Map(s)/Parcel Number(s): A I. T/279— /ircej i / Z. 7/n 79 -icayee /
CURRENT SERVICE AREA DESIGNATION (If any):
❑ Water and Sewer ❑ Water Only
❑ Water Only to Existing Structures ❑ Limited Service
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JUS IF=ON FOR ' •UEST: .r. i.ta/ e i i a•
�Lbs .bI Gam»,,ao G,- �-� �O Cb S� as•�c S c-.-
Civic/ . .:ei -
For Staff Use Only
DATE SUBMITTED( 9,19 L..` / I f7- DATE$130 FEE PAID: IG -�`' e -��
PROPERTY IS LOCATED (Check Appropriate): 6�` c'
❑ Inside or ❑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