HomeMy WebLinkAboutSE202200065 Application 2022-11-04•
•
APPLICATION FOR A SPECIAL EXCEPTION
/Request for a waiver, modification, variation or ❑
substitution permitted by Chapter 18
❑ Relief from a condition of approval
Provide the following
1 copy of a written request specifying the
section or sections being requested to be
waived, modified, varied or substituted, and
Variation to a previously approved Planned
Development rezoning application plan or
Code of Development
Provide the following
1 copy of the existing approved plan
illustrating the area where the change is
requested or the applicable section(s) or
the Code of Development. Provide a
graphic representation of the requested
change.
any other exhibit documents stating the reasons 1 copy of a written request specifying the
for the request and addressing the applicable provision of the plan, code or standard for
findings of the section authorized to be waived, which the variation is sought, and state the
modified, varied or substituted. son for the requested variation.
FEE = 523.12
Application $503 + Techno ogy surcharge $20.12
Project Name :
Current Assigned Application Number (US, HO, CLE, SDP, SP or ZMA)
Tax map and parcel(s): (0(ey
Applicant / Contact Person
Address �_ia [�� n �JCity
Daytime Phone#
Owner of Record
p14,"41� State V*Zip
Email
Address �� 'S' , (�� e } _{City (-) & t �� State Zir2eg
Daytime Phone# Email, 50A CL-ECe.4L-
/--L-C)¢.P/1
County of Albemarle
Community Development Department
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/ U2021
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APPLICATION FOR A SPECIAL EXCEPTION
APPLICATION SIGNATURE PAGE
If the person signing the application is someone other than the owner of record, then a signed copy of the
"CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE
LANDOWNER" form must be provided in addition to the signing the application below. (page 3)
Owner/Applicant Must Read and Sign
By signing this application, I hereby certify that I own the subject property, or have the legal power to act
on behalf of the owner of the subject parcel(s) listed in County Records. I also certify that the information
provided on this application and accompanying information is accurate, true, and correct to the best of my
knowledge. By signing this application, I am consenting to written comments, letters and or notifications
regarding this application being provided to me or my designated contact via fax and or email. This consent does
not preclude such written communication from also being sent via first class mail.
14igna of •r
FOR OFFICE USE ONLY APPLICATION#
By who?
Receipt #
Date
P/rS
Daytime phone number of Signatory
Fee Amount S Date Paid
Ck#
By
Revised 7/1/2021