HomeMy WebLinkAboutACSA201100102 Application 1997-04-09 APPLICATION TO AMEND THE of•AL8,� Countyof Albemarle
�� � Department of Planning and Community Development
SERVICE AUTHORITY ° ®-` 401 McIntire Road
JURISDICTIONAL AREAS �v1N1P� Charlottesvill804 296-5823e,VA22902a596
APPLICANT Name: ' I V/tl/� L , 67-o %T-ES/V.446
Signature: )C � � -�'' - Phone: Gi 7.7 —/, ?9/
Address: TEk'e_gL G "eJL. a"
(ehF4'L a 7 7'E S V,'LLB V/-. e /
CO-APPLICANT Name (or age , if any):K t /Ee L_ i7 ' C:=-O%T. /4/1I
Signature: Phone: 77-/,; /
Address: , _lv�� T� �C'EL L- kb. /-/
CIr-i/i9 Lri7TL SV/ V/1 g2 JD/
JURISDICTIONAL AREA DESIGNATION REQUESTED:
,Water and Sewer ❑ Water Only
O Water Only to Existing Structure(s) ❑ Limited Service (Describe in Justification
below)
i46-
PROPERTY LOCATION (Address)441107 ,CALL A9n
Tax Map(s)/Parcel Number(s): TM P /O - 70 b
CURRENT SERVICE AREA DESIGNATION (If any):
O Water and Sewer Water Only
❑ Water Only to Existing Structures 0 Limited Service
JUSTIFICATION FOR REQUEST: 5 c'u'e'‹ L,/1/6 /—G,o/7 5 '/? =%'r'O,h-9 i'?' }/
and f0 pro fig' c-71- CIS'oan d toa / r- . y5 fe m;r-� < na' `e-ar-
er&e k. . ALS o tt , res-e rye iocode d env, ton ma?11 t,
For Staff Use Only
DATE SUBMITTED: 4 ` 11 DATE$130 FEE PAID: 1-3 C• D O
PROPERTY IS LOCATED (Check Appropriate):
O Inside or ❑Outside a Growth Area? 0 Adjacent to SAJA?
❑ Inside or ❑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
01-&-tj