HomeMy WebLinkAboutLOD200700016 Application 2014-03-20 (2)Application for
Parcel of Record Determination and or Development
Project Name:
Tax wap and
is Determination
❑ Parcel of Record = $75
Development Rights = $40
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Magisterial District: \4161-:bt IkA11 Zoning: OvfrA 40,0.1
Contact Person (Who should w11''e call/write concerning this project?): :11 S%,,* J& ` /
Address A��� 9Wtfvt� ,qA, �O� City ,J& mrcvo State \1iZip 42c1 rj-(o S,1
Daytime Phone (64% li n • 13$o Fax # L_) E-mail
Owner of Record
Address IVI I %rO4," oe .,z City C"A&J\10,r_tateV')%S1%kk Zip 22901 `2$0l
Daytime Phone !3W 2a 3 • �1 Fax # (^) '— E-mail S�r
Applicant (Who is the Contact person representing?): ns•/ b i\>ztmv-d L -a5aVA
Address City State Zip
Daytime Phone Fax # L__) E-mail
Submittal Requirements
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 of Owner
Print Name
FOR OFFICE USE ONLY
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Fee Amount $ 1AN Date Paid
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Date
(SgG)ZI3t7 � 1380
Daytime phone number of Signatory
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Receipt'# 6 S c� i-Ck#_a15�_ By:
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fag: (434) 972-4126
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