HomeMy WebLinkAboutSE202300004 Application 2023-02-13•
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APPLICATION FOR A SPECIAL EXCEPTION
® Request for a waiver, modification, variation or ❑ Variation to a previously approved Planned
substitution permitted by Chapter 18 Development rezoning application plan or
Code of Development
OR
❑ Relief from a condition of approval
Provide the following
1 copy of a written request specifying the
section or sections being requested to be
waived, modified, varied or substituted, and
any other exhibit documents stating the reasons
for the request and addressing the applicable
findings of the section authorized to be waived,
modified, varied or substituted.
Provide the following
1 copy of the existing approved plan
illustrating the area where the change is
requested or the applicable section(s) or
the Code of Development. Provide a
graphic representation of the requested
change.
1 copy of a written request specifying the
provision of the plan, code or standard for
which the variation is sought, and state the
reason for the requested variation.
FEE = 523.12
Application $503 + Technology surcharge $20.12
Project Name
638 Rocky Hollow Rd Charlottesville VA 2911
Current Assigned Application Number (US, HO, CLE, SDP, SP or zMA) HS232300010
Tax map and parcel(s):
06200-00-00-071A2
Applicant / Contact Person Jonathan Birdsey
Address 640 Rocky Hollow Rd City Charlottesville
Daytime Phone# ( 561 ) 7063402 Fax# (
Owner of Record Adriana Tuerk
Address 148 S. Airport Rd
Daytime Phone# ( 561 ) 706-3402 Fax# (
City Islamorada
State VA Zip 22911
Email adri3387@yahoo.com
State FL Zip 33070
Email adri3387@yahoo.com
County of Albemarle
Community Development Department
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2021
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APPLICATION FOR A SPECIAL EXCEPTION
APPLICATION SIGNATURE PAGE
If the person signing the application is someone other than the owner of record, then a signed copy of the
"CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE
LANDOWNER" form must be provided in addition to the signing the application below. (page 3)
Owner/Applicant Must Read and Sign
By signing this application, I hereby certify that I own the subject property, or have the legal power to act
on behalf of the owner of the subject parcel(s) listed in County Records. I also certify that the information
provided on this application and accompanying information is accurate, true, and correct to the best of my
knowledge. By signing this application, I am consenting to written comments, letters and or notifications
regarding this application being provided to me or my designated contact via fax and or email. This consent does
not preclude such written communication from also being sent via first class mail.
de"k,T"w
Signature of Owner / Agent / Contract Purchaser
Adriana Tuerk
Print Name
FOR OFFICE USE ONLY APPLICATION#
By who?
Receipt #
02/03/2023
561-706-3402
Daytime phone number of Signatory
Fee Amount S Date Paid
Ck#
By.
Revised 7/1/2021
APPLICATION FOR A SPECIAL EXCEPTION
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany this zoning application if the application is not signed by the owner of the property.
I certify that notice of the application for, Jonathan Bi
was provided to Adriana Tuerk
type
owners
the owner of record of Tax Map and Parcel Number 06200-00-00-071 A2
by delivering a copy of the application in the manner identified below:
nHand delivery of a copy of the application to Adriana Tuerk
[Name of the record owner if the record owner is a person; if
the owner of record is an entity, identify the recipient of the
on 02/03/2023 record and the recipients title or office for that entity]
Date
F—IMailing a copy of the application to
[Name of the record owner if the record owner is a person; if
the owner of record is an entity, identify the recipient of the
record and the recipients title or office for that entity]
on 02/03/2023 to the following address
Date
[Address; written notice mailed to the owner at the
last known address of the owner as shown on the
current real estate tax assessment books or current real
estate tax assessment records satisfies this
requirement].
;Toayaha4v
Signature of Applicant
Jonathan Birdsey
Print Applicant Name
02/03/2023
Date
Revised 7/1/2021