HomeMy WebLinkAboutSDP201000005 Application Letter of Revision 1 2011-11-15FOR OFFICE USE ONLY
Fee Amount $
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Application for
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Letter--of Revision
[Letter of Revision = Pfo rr-'a'-� L �'
Final Site Plan Name and Number:
'L' v I '° o ov o rte"
Contact Person (Who should we call /write concerning this project ?): l"r TI L
Address d::v I"-C� r 1-A C-ZJ y
Daytime Phone (__j r--y -T' 3 9'2", Fax # ( )
State Zip
E-mail l-l&V- L`1e-V%;9'r411(9' At-'Me MALL -, • o rLcl
Owner of Record C--t5'0r ' T 1 ( A- c%.il-'LA=
Address 4 ° I M' I PN-n (tit: °j°q City C-1 V L t—t•l: State VA
Daytime Phone ( ) Fax # O
Applicant (Who is the Contact person representing ?): c:'" t" 1 fir' ° F
E-mail
Iz' t~ C-10 C'L-V?
Address City
Daytime Phone ( ) Fax # ( ) E -mail
SUBMITTAL REQUIREMENTS:
XThe appropriate fee,
V The site plan number that the change applies to,
&e'^A request letter describing the proposed changes from the owner or authorized agent,
V"4 copies of the plan that shows the proposed changes,
State
Zip
_ Zip
S/ Changes must be shown on the sheet or sheets from the approved final site plan, or on an I 1 "X 17" copy of that portion of the
approved final site plan.
Owner /Applicant Must Read and Sign
I hereby certify that the information provided on this application and accompanying information is accurate,
true and correct to the best of my knowledge and belief.
Signature of Owner, Agent Date
r i e t-b 71 e rx- 12, rr - l—�� w t-+1
Print Name
Daytime phone number of Signatory
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 1/1/2011 Page I of I