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HomeMy WebLinkAboutACSA199700001 Application 1997-03-20 APPLICATION TO AMEND THE -�,H3V 4t4. County of Albemarle ATTACHMENT Al iiii-m*.v. Department of Planning and Community Development SERVICE AUTHORITY ®,r..:: r� 401 McIntire Road JURISDICTIONAL AREAS :. 804 296-5823 Charlottesville,VA 22902-4596 APPLICANT Name: 14a-1 cpc.4 a_' r-4--c_ 1 I�c i Signature: ��. �i°e..��,� l �I� Phone: `�`Z 7-2 G, ( ir►�, 2 i �7 3'4 Address: cj L K c=y i c D2 , t)dZ. ©fir-iLa' 7c3 7 0. . Pc �rsc6--D S-1- C - VI 1.u=� t.'1�, 2 2 1 t I fit-1 c'-t7t�,r`YI4.G flfl, .Z9v Z. CO-APPLICANT Name (or agent, if any): Signature: Phone: Address: JURISD TIONAL AREA DESIGNATION REQUESTED: 'OPWater and Sewer 24ater Only ❑ Water Only to Existing Structure(s) ❑ Limited Service (Describe in Justification below) PROPERTY LOCATION (Address) K Y L J G'r S v 13 171 v1 S i (3)<.) Tax Map(s)/Parcel Number(s): STcL) '' P es r->! R 01- P-1- 20 r-2: u©,-•- *, G I�r CO S 1 -4- 7= bR(, I 1- i_S Svc b 1 V("Cr< CURREN SERVICE AREA DESIGNATION (If anr) '! Water and Sewer Water Only ❑ Water Only to Existing Structures 0 Limited Service 1c,egw wr=5i et oP?rs ow".lc_ yoTFb Ili To f .a.;Fr0vore cF A c Sf, ,ao i t' KvEY co 14m.cpc, r.9 gi' *ICb coo 4':71241 JUSTIFICATION FOR REQUEST: 7.. iJ i Ft( T=A t-L N'0, 1 M R-t J Pu ILn c> s(-t a h c_osi Am)x_rty T/oi..9 tor el Ark SC) L I - I9.Dil c TY [/,i )kc2 7 1; I.)& LL.)H s rz._ (,- t o ►A ),i+ir-:-.: bt= , 1-fef) )of ())1- &.l l.e_i4 Tor) D-:ram Nilgia so0ac�! fi 7,wiz ./iiidf�51/6,097i'Ul_r* Yn,pa op Nitoxaic 1 >��i l2 PPo��zi MS ra , q�r=1�Q»4 vL4 it)Ar' n T 44 ,q 1 7-11. /-t c 7 e"L i C ov...)TI .S r-icArc;=. q v i ND vY2 L 77 ram"/__,& itI/ li, 4)A71.5e. To ikis.f ,,,,,.F;S/ f9> 41. S c " u i(0/0, Csot=lZ-L-_--c--,opi For/ Staff Use Only DATE SUBMI h1'hD: 3 -� 0 - 91 DATE$130 FEE PAID: 0 -7 7 PROPERTY IS LOCATED (Check Appropriate): ❑ Inside or EfOutside a Growth Area? O" djacent to SAJA? El Inside or E Vutside a Water-Supply Watershed? L�J Adjacent to a Growth Area? Location and distance of water/sewer line proposed to provide service L n00' REQUEST FOR AMENDMENT ADOPTED: ❑ Yes❑ No Date of Action