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LOD200600023 Application 2006-08-02
1.� f sl Application for Parcel of Record Determination and or Development Rights Determination Project Name: ❑ Parcel of Record = $75 JR Development Rights = $40 _JZ) n-e.S 4- - o 0-ev-- JV ^eE Tax map and pareel(s): T� ®/ Magisterial District: 10 Zoning: 914 Contact Person (Who should we call/write concerning this project?): 1 f� O VK 0_5 H - j -J0 M e -S �% Address 7©® a D d/ �� �� /city � rl y 5 ✓, ! � Q , State Zip q3 b 1 �� Daytime Phone(�j3 I0-/0ZQ Fax#(f3�_ r 6q'_1©7-1 E-mail �.�)��Wye�`�'�e• � Owner of Record , ' t� La—s '4 , Jones aha `D t qna �OSTGr Jones Address 4"s Im 10 Ai f City State Zip Daytime Phone (_) Applicant (Who is the Contact person representing?) Fax # (_) E-mail Address City Daytime Phone (_) Fax # () E-mail Submittal Requirements 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 infonnation. 5. Cover letter stating the asstuned munber of parcels and development rights, with explanation of same. A fee is required for each separate parcel shown on the tax map. Signature of Or Goias// Jo Print Name Date Daytime phone number of Signatory FOR OFFICE USE ONLY LOD # bC� Fee Amount $ qQ3iy� B�J' %oYY1G►O JU700 Receipt#�C/1Ck# Z ZZ4/ By: Yq ` Date Paid g y who.? County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fag: (434) 972-4126 511106 Page 1 of 1