HomeMy WebLinkAboutLOD200600024 Application 2014-03-13)pplication for e oFA
Parcel of Record Determination and or Development�°� 9�
Rights Determination
❑ Parcel of Record = $75
Development Rights = $40
Project Name:
m C
Tax map and parcel(s): 30 _2A E Magisterial District: V�i(7 Zoning: Q LId`w'�]
Contact Person (Who should we call/write concerning this project?): )/' 1?A V
=' ) /�tsCil�r
Address 23 R"4 66Q A b City ';&f t l Y l State Zip o?21
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f,' �� Stime Phone ( f' 9g1/7)06 — Fax # L� E-mail K) 4 -.00010
Day
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Owner of Record
Address. 593 R E S
Daytime Phone ( Fax # L�
Applicant (Who is the Contact person representing?): �1
Address,
Daytime Phone L__) Fax #
Submittal Requirements
City z�r l yS u// ri____ State _ Zip 22�Y
E-mail
City
E-mail
State Zip
1. Tax Map Page
2. Last Instrument of record in the Clerk's Office of the Circuit Court of Albemarle County, Virginia on or prior to
December 10, 1980 that includes a plat or metes and bounds description of the property. (Highlight or underline
references to the subject property).
3. All plats and deeds of record after December 10, 1980, UP UNTIL THE PRESENT DATE. (Highlight or underline
references to the subject property).
4. Any other pertinent information..
5. Cover letter stating the assumed number of parcels and development rights, with explanation of same.
A fee is required for each separate parcel shown on the tax map.
Signature o Owner
a)oori
Print Name
��C� 6
Date —'
7?, q 9 �Ci r r �? 3 o 36157
Daytime phone number of Signatory
FOR OFFICE USE ONLY �. LOD #
Fee Amount $ �U V Date Paid"�� who? Receipt #
Countv of Albemarle Department of Community Develop,
401 McIntire Road Charlottesville, VA 22902 Voice: (434 6.-5832 Fax: (434) 972-4126
5/7/66 Page I of I