HomeMy WebLinkAboutACSA200800002 Application 2008-04-29 p1'" Comr Development Department,Zoning&
County of Ai mat-le • • • Current Development Division
4IK fit 401 McIntire Road Charlottesville,VA 22902-4596
~'41M1 Planning Application 1 Voice : (434)296-5832 Fax: (434)972-4126
PARCEL/OWNER INFORMATION
TMP 05900-00-00-017B0 Owner(s): GILLILAND,ELIZABETH H
Application# ACSA200800002
PROPERTY INFORMATION
Legal Description ACREAGE PARCEL B
Magisterial Dist. Samuel Miller Land Use Primary Residential--Single-family(incl. modular homes)
Current AFD Not in A/F District Current Zoning Primary Rural Areas
APPLICATION INFORMATION
House # Street Name Apt/Suite City State Zip
Street Address 575 BLOOMFIELD RD CHARLOTTESVILLE 22903-
Entered By: Carla Harris on 04/30/2008
Application Type Amend the Service Authority Jurisdictional Area
Project: Fennell Property/Boxberry 115,870.00
Received Date 04/29/2008 Received Date Final Total Fees $ 130.00
Submittal Date Submittal Date Final Total Paid $ 130.00
Closing File Date Revision Number
Comments:
Legal Ad
SUB APPLICATION(s)
Type Sub Application Date Comments:
APPLICANT/ CONTACT INFORMATION
Primary Contact
Name Elizabeth Gilliland Fennell Phone # (434) 295-7048
Street Address 575 Bloomfield Road Fax# ( ) -
City/State Charlottesville,Va zip Code 22903-0000
E-mail egfennell@mac.com Cellular# (434) 242-7582
Owner/Applicant
Name GILLILAND, ELIZABETH H Phone# ( ) -
Street Address 575 BLOOMFIELD RD Fax# ( ) -
City/State CHARLOTTESVILLE VA Zip Code 22903 6,001441;
-
E-mail Cellular# ( ) -
Signature of Contractor or Authorized Agent Date C917P e460,
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. Application to
Amend the Service Authority Jurisdictional Area 1 : '`
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end the Service Authority Jurisdictional Area=$130.00
Project Name: f�A4 eA e-r c /lax toe try Lt
Tax map and parcel: 5C1 / rt a Magisterial District:�- � �(N C � Groning: g A
Physical Street Address(if assigned): �7r' T 100 c Ud 1`O
Location of property(landmarks,intersections,or other): 2 veW L 1 Lf
eta✓ -hwwt i. cc c o F 2 C7) W
Contact Person(Who should we call/write concerning this project?): GL 1 SaiLiC LTA k\1 la,vxd F2.(A 0 e `I
Address 6 C)OD wkfl City CtL&owl 0{Faa Vl' State IJ rA Zip 22' 0 3
C Daytime Phone(" act A^ Fax#() ) E-mail 1-E-Vl N e-1 t t/�ac.Co vv.,use 2 c
Owner of Record t i iJ\A. (n j kl t i&vtct �e A sn e_1(
Address 1.--2. Ail °"^42-- City State Zip
Daytime Phone( ) Fax#( �) E-mail
Applicant(Who is the Contact person representing?): ��%u- p,K r i` & i. /
Address City State Zip
Daytime Phone( ) Fax#( ) E-mail
ACS fl 20o84 .2_
FOR OFFICE USE ONLY TMP# ,
Fee Amount$ 1`O, Date Paid � en
y who? 1 M g Receipt# 7 w(04 Ck#CR ICI �A A
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville,VA 22902 Voice: (434)296-5832 Fax: (434)972-4126
5/1/06 Page 1 of 2
•
Jurisdiction area designation requested
Water and Sewer
Water Only to existing structure(s)
Water Only
Limited Service(Describe in justification below)
Current Service Area Designation
z161,No designation
Water and Sewer
❑ Water Only to existing structure(s)
Li Water Only
❑Limited Service(Please describe )
Justification for request:
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I hereby certify that the information provided on this application and accompanying information is accurate, true
and correct to the best of my owledge and be1j f.
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SignaturejOwner, Contract Purchaser,Agent Date
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Print Name Daytime phone number of Signatory
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S ^ L) O 5/1/06 Page 2 of 2