HomeMy WebLinkAboutACSA200100004 Application 2001-01-22 s i
APPLICATION TO AMEND THE is..k.(2LA County of Albemarle
Department of Planning and Community Development
SERVICE AUTHORITY • 401 McIntire Road
}► Charlottesville,VA 22902-4596
JURISDICTIONAL AREAS Boa 296-5823
APPLICANT Name: � 13�1irn �� AlAlen, .1--A CA/F 1�, K�-1-
Signature:7(t5t"eiz. -1,/72 JJ0 c.�.�,..� ,fry A /K...eeet_.- Phone: 777— `ILZ 74
Address: l b / )7/Cal o Af'T (n 0 lei--
L.
CO-APPLICANT Name (or agent, if any):
Signature: Phone: --
Address:
JURISDICTIONAL AREA DESIGNATION REQUESTED:
❑ Water and Sewer E, Water Only
O Water Only to Existing Structure(s) 0 Limited Service (Describe in Justification
below)
PROPERTY LOCATION (Address) /0/ V/EG1fd n/-7- eT/
Tax Map(s)/Parcel Number(s): d 77150 O i)D 4- 00 70 6
CURRENT SERVICE AREA DESIGNATION (If any):
0 Water and Sewer 0 Water Only
❑ Water Only to Existing Structures 0 Limited Service
JUSTIFICATION FOR REQUEST: LIIFLL Uti t,, 7�W/5 EA- /S
1�/77f/ G A-nE D 71 YF2-aia Ai A-A'
For Staff Use Only /
DATE SUBMITTED: DATE$130 FEE PAID: l/
PROPERTY IS LOCATED (Check Appropriate):
O Inside or 0 Outside a Growth Area? 0 Adjacent to SAJA?
O 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: 0 Yes 0 No Date of Action •