HomeMy WebLinkAboutSDP200700043 Application Letter of Revision 1 2016-06-13 FOR OFFICE USE ONLY LOR#
Fee Amount$A,) ‘10,ei Date Paid By who?
Receipt# Ck#
By:
Application for
Letter of Revision
H Letter of Revision =$108
Final Site Plan Name and Number: S-) P _ Z 007 — ( 3
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Contact Person(Who should we call/write concerning this project?): / Ski-1;A;
Address 27S/ 16d/a LI'C / /
4 ' City C4L— (( State Of Zip 2 2 X Q//
Daytime Phone( 3 ) 97.57 9 3 yo Fax#( 9 75✓ 5' 34/./ E-mail q 5 /«
Owner of Record 4 7 r1 ('d-',1 t Sc
Address 2-7.5-1 /{ C/C4 L
City C4 v,(7Z State # Zip 2 24 u%
Daytime Phone d1,) `(7 f 7 j`1 U Fax#( ) E-mail K' /'/</1:4/ /
Applicant(Who is the Contact person representing?): /1/ 1";°1 s!�e Cc✓,1 15 Sc`ctu7j .76/r.y
Address 2 ! /�� City /' c,
7 Sf' �7`1 (� l L �Z� CA State V I+ Zip 2'2 S CJS
Daytime Phone(40 4 7S S 3L/U Fax#( ) E-mail 5 1,-4,t f
SUBMITTAL REQUIREMENTS:
❑ The appropriate fee,
kfThe site plan number that the change applies to,
A request letter describing the proposed changes from the owner or authorized agent,
V 4 copies of the plan that shows the proposed changes,
❑ 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 certify that the information provided on this application and accompanying information is accurate,
true and correct to the best of my knowledge and belief.4
Signature of Owner, Agent Date
h r 0,1 5 `/3' — 17 5 9 3 Y6-I
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 11/1/2015 Page 1 of 1