HomeMy WebLinkAboutLOD200700020 Application 2014-03-17 (2)Application for
OF A
Parcel of Record Determination and or Development
kn
RiLyhts Determination
❑ Parcel of Record = $75
0 Development Rights = $40
Project Name:
Tax map and parcel(s): Magisterial District: Zoning:
Contact Person (Who should we call/write concerning this project?):
Address City 6 �e7 / S Zpj �/r' State ( � Zip
Daytime Phone �l° J� % Fax # (_� �1/�� "'' E-mail
Owner of Record
Address
Daytime
Applicant (Who is the Contact person representing?):
Address
city /G State &C—, Zip
—6 L�3� E-mail
State
Daytime Phone % /� 7� Fax # L E-mail `s
Submittal Requirements
1. Tax Map Page A' r -'71 `J
2. Last Instrument of record in the Clerk's Office of the Circuit Court of Albemarle County, Virginia on or prior to
December 10, 1980 that includes a plat or metes and bounds description of the property. (Highlight or underline
references to the subject property).
3. All plats and deeds of record after December •10, 1980; UP UNTIL THE PRESENT DATE. (Highlight or underline
references to the subject property):
4. Any other pertinent information.
5. Cover letter stating the assumed number of parcels and development rights, with explanation of same.
A fee is required for each separate parcel shown on the tax map.
Sign4 ure of er
rr �. C
Print Name.
Date
Daytime phone number of Signatory
FOR OFFICE USE ONLY L D # (A VV v Lf!;P� 1W ambw
obq) 7l 1 �25c 5 35 �-
Fee Amount$ Date Paid l� y who. Receipt CJ ULL
County of Albemarle Department of Community It, v
gent
401 McIntire Road Charlottesville,.VA 22902 Voice: (434) 2� �ly
511106 Page I of 1