HomeMy WebLinkAboutACSA199500004 Application 1995-05-22 APPLICATION TO AMEND THE �..;( A`-4c'1, County of Albemarle
�?�N I;bpi .lp Department of Planning and Community Development
SERVICE AUTHORITY =i; 401 Mt e VAad 22902-4596 ;
��� �'- ��� 2 2 1995
JURISDICTIONAL AREAS 804 296-5823 •
Dianning Dept.
APPLICANT Nai // /Z (�
Signature: - Phone:7"
. ,'tS 6 - Y752Z
�Lbzi� i
Address: /�'t7. 62 C [, 1,
Z2132-
CO-APPLICANT Name (or agent, if any):
Signature: Phone:
Address:
JURISDICTIONAL AREA DESIGNATION REQUESTED:
❑ Water and Sewer 0 Water Only
❑ Water Only to Existing Structure(s) 2rLimited Service (Describe in Justification
below)
PROPERTY LOCATION (Address)
Tax Map(s)/Parcel Number(s): 5 / 14
CURRENT SERVICE AREA DESIGNATION (If any):
❑ Water and Sewer 0 Water Only •
❑ Water Only to Existing Structures ❑`Limited Service
JUSTIFICATION FOR REQUEST: 04-4 a[kg- COMA41,54 loot%
For Staff Use Only
DATE SUBMIT-11D: DATE $130 FEE PAID:
PROPERTY IS LOCATED (Check Appropriate):
0 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: ❑ Yes ❑ No Date of Action