HomeMy WebLinkAboutACSA200200003 Application 2002-04-24 APPLICATION TO AMEND THE � County of Albemarle
i F11111 ,9vt Department of Planning and Community Development
SERVICE AUTHORITY • -®,' 401 McIntire Road
Charlottesville,VA 22902-4596
JURISDICTIONAL AREAS ,P 804 296-5823
APPLICANT Name: a v C,�t. a. >�
Signature: �L(.(w,,JL.. Q )1+ / Phone: 4 3 SI- 9 73- 6 c 3
Address: 3 Sf)3 _hxf
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CO-APPLICANT Name (or agent, if any):
Signature: Phone:
Address:
JURISDICTIONAL AREA DESIGNATION REQUESTED: "
❑ Water and Sewer l W/ater Only
❑ Water Only to Existing Structure(s) 0 Limited Service (Describe in Justification
below)
PROPERTY LOCATION (Address) 3 S 03 IG rur< Cp � �59-/1
7 -' //
Tax Map(s)/Parcel Number(s): Si G b v b O 4 /f D
CURRENT SERVICE AREA DESIGNATION (If any)::
❑ Water and Sewer Water Only
❑ Water Only to Existing Structures 0 Limited Service
JUSTIFICATION FOR REQUEST: ,.c tkt- L 0 .1 Cl,
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1`1n--(�i- Latta. a te-- L'It oLW.. eent.9.0 u p .Co-- __,L wa .s D41 .441
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For Staff Use Only
DATE SUBMITTED: i A DATE $130 FEE PAID6a%
PROPERTY IS LOCAT D (Check Appropriate):
LI Inside or ❑Outside a Growth Area? ❑ Adjacent to SAJA?
❑ Inside or ❑Outside a Water-Supply Watershed? ❑ Adjacent to a Growth Area?
Location and distance of water/sewer line proposed to provide service
REQUEST FOR AMENDMENT ADOPTED: 0 Yes❑ No Date of Action
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