HomeMy WebLinkAboutACSA199700008 Application 1996-11-25 APPLICATION TO AMEND THE ‘.t ALB4� County of Amemarle ATTACHMENT A
r Department of Planning and Community Development
SERVICE AUTHORITY 8 r., 401 McIntire Road
`1 Charlottesville,VA 22902-4596
JURISDICTIONAL AREAS �vnutio- 804296-5823
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Signature: i de TRt15TEE Phone: z-°13 - $1 ci
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CO-APPLICANT Name ( r .fan ): VI.)R-r- NI A. ( ,Lc, E_C1Z 1,I1✓ . -LT i
Signature:, c Ak, V.A4 Phone: 97 1 - IS 9 I
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Address: 2� 4 So ► \J'f Rp,4r- 1 -V ITT 11
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JURISDICTIONAL AREA DESIGNATION REQUESTED:
❑ Water and Sewer 0 Water Only
❑ Water Only to Existing Structure(s) t. Limited Service (Describe in Justification
below) 5 vJ -
PROPERTY LOCATION (Address) 1
Tax Map(s)/Parcel Number(s): a P, tir-oT Z\ le, SFs - GC % G 8(T.
I 1 1
CURRENT SERVICE AREA DESIGNATION (If any):
❑ Water and Sewer ❑ Water Only
❑ Water Only to Existing Structures . 0 Limited Service
JUSTIFICATION FOR REQUEST: - At R-1=3 S t V' t .E -j-\c, 'F 1 F, S
-A -FA1 1.-. D 01A CA U Q 1'1-5 ( 13 1AD2001‘A .
For Staff Use Only n/
DATE SUBMI ITED: //- 25-�.6 DATE$130 FEE PAID: 4/d d.02S 19,k ��'
PROPERTY IS LOCATED (Check Appropriate):
❑ Inside or 0 Outside a Growth Area? 0 Adjacent to SAJA?
❑ Inside or 0 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 0 No Date of Action