HomeMy WebLinkAboutSDP201000029 Application Letter of Revision 1 2012-09-13Application for
_
Letter of Revision
XLetter of Revision = $100
Final Site Plan Name and Number: A{1 NN
Contact Person (Who should we call/write concerning this project?):
Address __ _ V F Ai>`�l 'St' 1' F City {)1\ 1-S r. _- —State__. '4N_ Zip
Daytime Phone () a5L- 19Q� Fax # ()5 1 E -mail (tyiL `L (,y
Owner of Record
Address JS C"3_ L--� g I r,Ql r�, City t 1,-,L CSX{ 1 LF State Wig_ Zip
Daytime Phone (ij,�W I5.A -- at: � Fax # �_� E -mail
Applicant (Who is the Contact person representing ?):
Address
Daytime Phone (_,
SUBMITTAL REQUIREMENTS:
Fax # (_)
City
XThe appropriate fee,
XThe site plan number that the change applies to,
A request letter describing the proposed changes from the owner or authorized agent,
4 copies of the plan that shows the proposed changes,
E -mail
State Zip
Changes must be shown on the sheet or sheets from the approved final site plan, or on an 11 "X17" copy of that portion of the
approved final site plan.
Owner /Applicant Must Read and Sign
I hereby rtify that the information provided on this application and accompanying information is accurate, true and correct to the
I
m led e a belig,>rt
Sig ture f Owner, Agent Date
J- Ali �.� i �li YYI .S L/3 q- Sy_ 73Q5"
Print Name Daytime phone number of SiQnatory
FOR OFFICE USE ONLY LOR #
Fee Amount $� Date Paid ' H 3 12
By who? '^' i ' jA�eccipt # `-j /�
Z(;p Cltt# I g ; rn
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 9724126
1/1/2411 Page 1 of I