HomeMy WebLinkAboutACSA201100100 Application 2001-03-02 APPLICATION TO AMEND THE , °F Ai0.. County of Albemarle
;p9 Department Planning and Community Development
SERVICE AUTHORITY • ?'®=m 401 McIntire Road
w► Charlottes
804296-5vi823lle,VA 22902-4596
JURISDICTIONAL AREAS ` 1P
APPLICANT Name: k--)0 l (,t/li /(
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Signature: cc r)._ X )7/�//t c��-r.,-�_ Phone: 7.? /6."- L
Address: 5 //cRki/,� — ))/{:&Zr/A_()j ti S /%
CO-APPLICANT Name (or agent, if any):
Signature: Phone:
Address:
JURISDICTIONAL AREA DESIGNATION REQUESTED:
❑ Water and Sewer ❑Water Only
❑ Water Only to Existing Structure(s) 0 Limited Service (Describe in Justification
below)
PROPERTY LOCATION (Address)
Tax Map(s)/Parcel Number(s): /t/ 67d7
CURRENT SERVICE AREA DESIGNATION (If any):
❑ Water and Sewer EKWater Only
❑ Water Only to Existing Structures 0 Limited Service
JUSTIFICATION FOR REQUEST: et vciaac i -f-e_cl Gc2'Q /0 z- ' 5:7-i 'Q
For Staff Use Only
DATE SUBMITTED: ,/ /( / DAT 130 FEE PAID: (-39
PROPERTY IS LOCATED (Check Appropriate): < Vetv
❑ 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: ❑ Yes 0 No Date of Action