HomeMy WebLinkAboutACSA199800001 Application 1998-01-30 APPLICATION TO AMEND THE °F.� County of Albemarle
- AM ip 9� Department of Planning and Community Development
SERVICE AUTHORITY �T=`� �� Road
lottesville,VA 22902-4596
JURISDICTIONAL AREAS 804 296-5823
APPLICANT Name: �J//0
Signature: %/ gilir _ Phone: D3 S i - .��
Address: lf;14,///
#(e2o z)-- ass— `f 33/
CO-APPLICANT Name (or agent, if any):
Signature:_ Phone: -
Address:
11111
JURISDICTIONAL AREA DESIGNATION REQUESTED:
❑ Water and Sewer Water Only
❑ Water Only to Existing Structure(s) ❑ Limited Service (Describe in Justification
below)
PROPERTY LOCATION (Address) bee-wa JAN $0•
Tax Map(s)/Parcel Number(s): 40. 1G(5 oft
•
CURRENT SERVICE AREA DESIGNATION (If any): 2
❑ Water and Sewer ❑ ater Only •
ba Water Only to Existing Structures ❑ Limited Service
JUSTIFICATION FOR REQUEST: d teaii- Wg44,11 7 ?MO 77716 Go ' i-TIa&J F 'I
f N0/N bi44T1>t`. AS " P'Tly' 7119. 5/NGLS FA• 4IU./ Pli4Nlv5D aV Th/i5 2•G 4REz
LOT /5 4•P✓4c r 7b 4 GoavT ' WitAKAwa DN wa6PAAV / PflaV/!J/tI ftJ, 21c 44'47
seRvic.a. 47-77}/S MRr/cU64f GGee¢n'oAf s,yoc%-i) ivor Yl l L 7' /41,04T
For Staff Use Only
DATE SUBMI 1-I•bD: DATE $130 FEE PAID:
PROPERTY IS LOCATED (Check Appropriate):
❑ Inside or ❑Outside a Growth Area? ❑ Adjacent to SAJA?
❑ Inside or ❑Outside a Water-Supply Watershed? ❑ Adjacent to a Growth Area? 1111
Location and distance of water/sewer line proposed to provide service
REQUEST FOR AMENDMENT ADOPTED: ❑ Yes❑ No Date of Action
I. 1
County of Albemarle N o 19797
Virginia
DEPARTMENT OF PLANNING rr1�
Charlottesville,Va.,gd//2/ v 19 Y
RECEIVED OF C�r ;L,
`% LQ Li j ) 4-td,'1 Dollars "100
Cents $ / V' V()
For a On CI 3o ) 3O ? O
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