HomeMy WebLinkAboutZMA201600009 Application 2016-04-19 Community Development-Department
/41b e m a rie Cot --Ity
,..._Icintite'RoadCharlottesilie VA 22902,4596
111.Voice 1;434)296-E:832 Fay. (434972-4t2
Planning Application
!PARCEL TOWNER INFORMATION,
T7'.1P 04500-00-00-11200 Owner(s) WOOD, STtJARD R JR & MARGARET E
Application# ZMA201600009
LPROPERTY INFORMATION
Legal Deseript,on I ACREAGE
Magisterial Dist, Rio LJLand Use Prima-, Forest
Current AFD Not in A/F District :11D' Current Zoning Prmter, R6 Residential Eii
APPLICATION INFORMATION
Entered Sy
Street Address
application Type Zoning Map Amendment mielle Fipth
4 19,202_6
Prjet W‘rad Von Starch Rezoning
Received Date 04/18/16 Re,:e,,ed Date EInai Subrnittal Date 04/18/16 Total Fees
Clueing Elle Date Submittal Date Final Total Paid
Revielun Number
• ••
C0'Imertts ARS OK-TAXES PAID
Legal Aid
SUB APPLICATION(s)
5ttb Comment
APPLICANT CONTACT INFORMATION
Cont.actT Name 4ddress .„:„.3 State L. j Phone Phonecell
?TDD STIPIRD R 3R&MARGPRET E Pa all: EARLYSVILLE VA 22936
r-,EET •CHARLOTTESVILL 22902 4342455804
CHARLOTTESVILL 22502 4342455804
.`7.ognature of Contractor or Authorized Agent
: t
County of Albemarle
"*"°' Parcel Property Information "Niiv -;,-
,
---,
IMP 04500-00-00-11200 Legal ACREAGE
Description
Parent IMP
Tax Map 04500 Sectori 00 Block 00 Parcel 11200 G.PIN 491275921614
Major Subdiv, Acreage Total Acres 2.64 IMP Inactive? ACTIVE
L..... _ ,
L
rE-91 1 STREET ADDRESS INFORMATION
HOuse Nuttk': Street Name Cdy _ State Lk:ode ,,1
LOILNER INFORMATION
CJSa
WOOD,STUARD ft JR&MARGARET E :!.P 0 BOX 28 i EARLYSVILLE VA 22936
ADDITIONAL PROPERTY INFORMATION --1
Agricultural Forest District, Nckt in AtIF District i..iigh School Districti Albemarle LI
,
Traffic Zone: 248 Middle School District Burley !
Voter Precinct: AQnor-hurt i
v., Elem.School District, Ar-Hurt .-.
Magisterial District:. Ric I
......
Census Block Group,: 1, -.)
Metro Plarming Area'
CATS.Aree7 Census Tract' 108 v i
r,_,
Public Water Se r Water&Sewer H if'ater Supply Protection Area? : NO Other Rural Land? NO
Vi atersheo, Riduth Fork Rivanna (below r.e"1 Development Area? YES
Lr --- .
,Histortcal Significance
..,,...;.kid i-ieritage. See National Historic Landr,a rl•, Virginia Landmark:Register National Register of Historic Maces
. ......._
Parcel Has Proffers Parcel Has Easements
,
Cu rent Land Use 1 1 fiQmt-er of Structures rimer of Dlling Une5
_rcli
"-i
ZE..:cr,da,,, Llaassigrikkd 0 0
unaos,oned 1
'', Q . Q
.,.......
.Comprehensive Plan Land Use I , ,
i Nan 4.rea, NeIghborhood I - Places 29 ....
...„........„„______ ...„.„...,. ............,...„.....
Pnrnar,' Office./R 8 01 Flex y Lioht industrial v Other:
Secondary ii . Commercial mixed use v . Other . Uri,,,,:
i
m'n'ori Onassioned ,1 °thar.4 Lines,:
-----4 .
Other,' Urtassioned ,'P.! Othier5, una..,ii,_ , ie
Zoning 1 _
;..tairerir Zorisnig ::::- --..f -::::iiits-sio .::: :S.3: Zaniftia Pnor ro.12.12 980
rm.-1
Prfrnarv, R6 Residential LeJ R6 Residentai k- i'-' I- - i'i-- dential
, ,
Secondary Unassigned IFI Airoort Noise Over.e.,, -i- -.led I.4,l
Minor Unassigned H Alroort Protection Overlay ,..„ .:..--.,,,....ned L.j
,_....,
other Unassigned v Natural Resource Extraction Overlay Flood Hazard Overlay
Airport impact Area Entrance Corridor Overlay Scenic Stream Overlay
ACTIVITY INFORMATION
ex.i7LOPVG 4 C77`477s9
AfelisationNumbyiCurrareermitSt 1S2eciatconeo!!___1
B19,9'SOC.3:1MOI CO Issued
SDP19970008: --::ocved .i'
SOP19960009:
.50P199600012 ,:.,ppro,eth
EDA3.9950003S .Approved ,..
'---, I
- ,
SDP199.30004-7 Denied ' v 1
PrinfedOn: Nel—sday AprO 19,2016
Tax Year All • Pay Status Both • Record Type Real Estate •
Search By Parcel ID Number • 04500000011200
Search Tips
Increase the speed and accuracy of your Tax Search:
• Select a Tax Year
• Select a Pay Status
• Select the Record Type
Personal Property requires your Account Number,Zip Code,and
Last 4 digits of your SSN.If login fails change SSN to last 4 of your
Driver's License.If unsuccessful please contact the Tax Office.
• Choose Search Criteria
• For Name Searches use Last Name followed by First name
Example:Smith,John
Invoice Tax Inst Owner Name Description Record Due Date Date Paid Status
Year Type
189300E 2010 1 WOOD,STUARD RJR& NO SITUS Real 6/7/2010 6/5/2010 ve
MARGARET E I ADDRESS 1 Estate Paid
1//ACREAGE
89301 201= 2 [WOOD,STUARD R JR& N SITUS Real 1216/2010 12/512010
t,lARGARETE Au DRESS Estate P t
//AC;REAGE
0189302 2u 11 1 vV00D,STUARD R JR& NO SITUS 6/6/2011 6/5/2011 401
i 1 MARGARET E I ADDRESS LS t.=-_ I Paid
1 //ACREAGE
189303 011 2 WOOD,S1`UAFZD R JR& NO SITUS Real 12/512011 12/5/2011 '
MARGARET E ADDRESS Estate Paid
‘`` 11 ACREAGE
11893041 2012 i 1 !WOOD,STUARD .: :. NO SITUS r5.,,, J,. - ,G
( E
I MARGARET E !ADDRESS Esta-� 1 Paid
'//ACREAGE
'180:305 ?0;2 2 WOOD,STUARD R JR& NO SITUS Real 1215;2012 1215/2(1112 • :..
MARGARET E ADDRESS Estate Paid
• "ACREAAGE
=189306 2013 1 !WOOD,STUARD R JR& .NO SITUS ;Real 6/5/2013 6/3/2013 ' tk' '
MARGARET E ADDRESS 'Estate Paid
i //ACREAGE
180307 2013 2 '' /'' n STUARD R JR& NO SITUS Real 12/512013 12/2:2013
'ARGARE T E ADC RESS Estate Paid
/T ACREAGE
118 t_5 e.11 .Lti 4 1 ,r'iv v L..7L,A'_ al p '16/5/2014 6/5/2014 I. I
;MARGARET t ,-. 1 Paid
189309 2014 2 IVOGO,STUARD R JR& NO SITUS Real 12/5/2014 11/13/2014
MARGARET ADDRESS Estate Paid
1089661 2015 1 WOOD,STUARD R JR& I NO SITUS 1 Real .6/5/2015 ',:6,/5/2015
I MARGARET E ADDRESS i Estate I Paid
1 //ACREAGE E 1
1€8966 2015 2 'VOOD STUARD R JR& NO SITUS Real 12;7/2015=: ' 015
MARGARET E ADDRESS Estate Paid
//ACREAGE
Tax Year All • Pay Status Both • Record Type`Real Estate •
Search By Parcel ID Number • 045000000112e0
Search Tips
Increase the speed and accuracy of your Tax Search:
• Select a Tax Year
• Select a Pay Status
• Select the Record Type
Personal Property requires your Account Number,Zip Code,and
Last 4 digits of your SSN.If login fails change SSN to last 4 of your
Driver's License.If unsuccessful please contact the Tax Office.
• Choose Search Criteria
• For Name Searches use Last Name followed by First name
Example:Smith,John
Invoice Tax Inst Owner Name Description Record Due Date Date Paid Status
Year
Type
189352,20101 I MCMAHON,BRIAN J& 3400 BERKMAR DR Real 6/7/2010 6/4/2010 r
I STEPHEN K VON ST
CHARLOTTESVILLE,VA Estate Paid
122901
89353 2010 2N1CMA lON,BRIAN J& 3400 BERKAJAR DR Real 12.'6:2010 1215/21110
STEPHEN K VON ST CHARLOTTESVILLE,VA Estate 1'aid
22901
?IX! ACREAGE
€189354 2011 1 MCMAHON,BRIAN J& 3400 BERKMAR DR i Real 6/6/2011 i 6/2/2011 V
6 STEPHEN K VON ST CHARLOTTESVILLE,VA �Estate 3
22901 1 Paid
AC
18 355 2011 2 MCM,-1('N,BR IA1,4 J& 3400 BERKMAR DR Real 12/5/2011 12/20/2011
STERNEN K VON ST CHARLOT-TESVILLE,VA Estate Pal=
22901
X,'/ACREAGE
189356 2012 1 MCMAHON,BRIAN J& 3400 BERKMAR DR Real j 6/5/2012 5/11/2012
STEPHEN K VON ST CHARLOTTESVILLE,VA Estate Paid
22901
X'At RFAGF
- «...-a
139357 2012 2 '41C3MAl- 01\1,,BRIAN J& 340t3 BERKMAR DR Real 12/5/2012 11/20/2012
STEIDHEN K VON ST CHARLOTTESVILLE,VA Estate Paid
22901
GREAGE
•
189358 2013 1 MCMAHON,BRIAN J& 3400 BERKMAR DR Real '6/5/2013 '5/15/20
STEPHEN K VON ST CHARLOTTESVILLE,VA Estate Paid
22901
X//ACREAGE
189359 2013 2 MCIVIAI-ION,BRIAN J& 3400 BERKMAR DR: Real 1'2/5'2013 11/42/204')
STEPtiEN K VON ST CHAFRLOTTESVILLE VA Estate Pd
31
22901
X/1 ACREAGE
189360 2014 1 MCMAHON,BRIAN J& ,3400 BERKMAR DR Real ,6/5/2014 6/5/2014 Ai
STEPHEN K VON ST CHARLOTTESVILLE,VA Estate Paid
22901
X//ACREAGE
189361 2014 2 MCMAHON,BRIAN J& 3400 BERKMAR DR Reil 12/5x''2014' 11125/2014
STEPHEN K VON ST CHARLOTTESVILLE,VA Estate Paid
22901
X11
IFee Amount$ Date Paid lispotty who? Receipt#Sied Ck# By:
ar.
Application for V `iF,,
pp Vzit:2_,.
Zoning Map Amendment
`ikGiNv'
PROJECT NAME:(How should we refer to this application?) Wood Von Storch Rezoning
TAX MAP PARCEL(s): 45-112, 45-112E
Does the owner of this property own(or have any ownership interest in)any abutting property? If yes,list those tax map and parcel numbers
PROPOSAL:REZONE 4.428 ACRES PROPOSAL:AMEND ZMA- -
FROM R-6 ZONING DISTRICT by doing the following:
TO C-1 ZONING DISTRICT ❑ By adding Acres
EXISTING COMP PLAN LAND USE/DENSITY: from Zoning District
Office/R&D/Flex/Mixed Employment/Commercial
to Zoning District
LOCATION/ADDRESS OF PARCEL(S)TO BE REZONED:
East Side of Berkmar Drive, behind Keglers ❑ Amcnd an existing Planned District
❑ Amend existing proffers
CONVENTIONAL DISTRICTS—RA,VR,R-1,R-2,R-4,
R-6,R-10,R-15,C-1,CO, HC,LI,HI,and DCD zoning 111 Amend a Code of Development
districts EXISTING COMP PLAN LAND USE/DENSITY:
PLANNED DEVELOPMENT DISTRICTS -MHD, PRD,
PUD,NMD,PDMC, PDSC,and PD-IP zoning districts. LOCATION/ADDRESS OF PARCEL(S)TO BE REZONED:
Are you submitting a preliminary site plan with this application? 0 YES
Are you submitting a preliminary subdivision plat with this application? 0 YES IO
Are you proffering a plan with this application? ❑ YES p�, 'NO
Contact Person(Who should we call/write concerning this project?): Frank R. Stoner
300 2nd Street NE Charlottesville VA 22902
Address City State Zip
Daytime Phone( ) 245-5804 Fax#( ) E-mail fstoner@milestonepartners.co
Owner of Record Stuard R. Wood/Stephen von Storch& Brian McMahon
250 Chestnut Oak Lane Charlottesville VA 22903
Address_ City State Zip
Daytime Phone( ) 295-4204 Fax#( ) E-mail <svonstorch@s-vs.com>
Applicant(Who is the Contact person representing?): Milestone Partners, LLC/Stephen von Storch & Brian McMahon
300 2nd Street NE Charlottesville VA 22902
Address City State Zip
Daytime Phone( ) 245-5804 Fax#( ) E-mail fstoner@milestonepartners.co
County of Albemarle
Department of Community Development
401 McIntire Road Charlottesville,VA 22902 Voice: (434)296-5832 Fax: (434) 972-4126
Zoning Map Amendment Application Revised 11/02/2015 Page 1 of 4
applied with reasonable c( •deration for the existing use and chary j of property, the comprehensive
plan, the suitability of proprty for various uses, the trends of growtlror change,the current and future
requirements of the community as to land for various purposes as determined by population and economic
studies and other studies,the transportation requirements of the community, the requirements for airports,
housing, schools,parks,playgrounds, recreation areas and other public services,the conservation of natural
resources,the preservation of flood plains, the preservation of agricultural and forestal land, the
conservation of properties and their values and the encouragement of the most appropriate use of land
throughout the locality."
REQUIRED ATTACHMENTS & OTHER INFORMATION TO BE PROVIDED for
THE APPLICATION TO BE OFFICIALLY SUBMITTED
iOne(1)completed & signed copy of the appropriate checklist(see list on page 3).
U One(1)copy of the Pre-application Comment Form received from county staff
Line(1)copy of any special studies or documentation as specified on the Pre-application Comment Form
ay
Seventeen (17)folded copies of a Conceptual Plan for conventional zoning districts(see districts on page 1)
OR
❑iSeventeen
Seventeen (17)folded copies of an Application Plan for planned development districts(see districts on page 1)
(17)copies of a written narrative with section TITLES as follows:
• PROJECT PROPOSAL
The project proposal, including
o its public need or benefit;
(be as descriptive as possible)
• For proposed Neighborhood Model District(NMD) -Provide a statement describing how the
proposed district satisfies the intent of Chapter 18 and if one or more characteristics of the
neighborhood model delineated in section 20A.1 of Chapter 18 are missing from the application,
then provide a justification as to why any characteristics cannot or should not be provided with the
proposal.
• CONSISTENCY WITH COMPREHENSIVE PLAN
The proposed project's consistency with the comprehensive plan, including the land use plan and the master
plan for the applicable development area;
• Proposed Neighborhood Model District(NMD) -Provide a narrative as to the project's
consistency with the neighborhood model.
• IMPACTS ON PUBLIC FACILITIES &PUBLIC INFRASTRUCTURE
The proposed project's impacts on public facilities and public infrastructure.
• IMPACTS ON ENVIRONMENTAL FEATURE
The proposed project's impacts on environmental features.
• PROPOSED PROFFERS TO ADDRESS IMPACTS
The proposed proffers to address impacts from the proposed project.
Proffers are voluntary offers to use property in a more restrictive way than the overall zoning district
classification would allow. By State Code,proffers must have a reasonable relationship to the rezoning and
are not mandatory. The rezoning must give rise to the need for the proffers;the proffers must be related to
the physical development or physical operation of the property; and the proffers must be in conformity with
the Comprehensive Plan.
REQUIRED ATTACHMENTS CONTINUED
Zoning Map Amendment Application Revised 1 1/02/2015 Page 2 of 4
2 One(1)copy of the most recMnt recorded plat,that shows the Deed BodPage Number,of the parcel(s)
composing the proposed project,or a boundary survey if a portion of one or more parcels compose the proposed
project,both of which shall include a metes and bounds description of the boundaries.
U One(1)copy of ownership information (if applicant is not also the owner).
If ownership of the property is in the name of any type of legal entity or organization including,but not limited to,
the name of a corporation,partnership or association,or in the name of a trust,or in a fictitious name,a document
acceptable to the County must be submitted certifying that the person signing below has the authority to do so.
If the applicant is a contract purchaser,a document acceptable to the County must be submitted containing the
owner's written consent to the application. If the applicant is the agent of the owner, a document acceptable to the
County must be submitted that is evidence of the existence and scope of the agency. Please attach the owner's
written consent.
��/See Attachment A in the Land Use Law Handbook for more information.
IJ As the owner/agent I certify that any delinquent real estate taxes, nuisance charges, stormwater management utility
fees,and any other charges that constitute a lien on the subject property,which are owed to the County of Albemarle
and have been properly assessed against the subject property, have been paid.
For a Neighborhood Model District(NMD) - new or amendment of an existing NMD
U Seventeen(17)copies of the Code of Development satisfying the requirements of section 20A.5.
U One(1)copy of a parking and loading needs study that demonstrates parking needs and requirements and includes
strategies for dealing with these needs and requirements, including phasing plans,parking alternatives as provided in
section 4.12.8,and transportation demand management strategies as provided in section 4.12.12;provided that the
applicant may elect to submit the parking and loading needs study in conjunction with the preliminary site plan for
the development if it determines that the uses that may occupy the buildings are not sufficiently known at the time of
the zoning map amendment.
U One(1)copy of strategies for establishing shared stormwater management facilities, off-site stormwater
management facilities,and the proposed phasing of the establishment of stormwater management facilities.
OPTIONAL ATTACHMENTS:
U Proffer Form signed by owner(s)(1 copy).
U Additional Information, if any. (17 copies)
THE FOLLOWING ZONING DISTRICT CHECKLISTS WILL BE USED BY BOTH THE APPLICANT AND
STAFF DURING THE MANDATORY PRE-APPLICATION MEETING.
ALSO CONSULT THE OTHER DOCUMENTS BELOW BEFORE SUBMITTING AN APPLICATION:
CONVENTIONAL ZONING DISTRICT
CHECKLIST STAFF ANALYSIS OF ZMA& SP REQUESTS
PLANNED DEVELOPMENT ZONING DISTRICT WATER AND SEWER EVALUATION CHECKLIST
CHECKLIST
PLANNING COMMISSION REQUEST FOR INFO
NEIGHBORHOOD MODEL DISTRICT
CHECKLIST
PROFFER FORM(MS Word doe)
Zoning Map Amendment Application Revised 11/02/2015 Page 3 of 4
Owner/Applicant Must Read and S
I hereby certify that I own the subject property, or have the legal power to act on behalf of the owner in filing this application.
I also certify that the information provided on this application and accompanying information is accurate,true, and correct to
the best of my knowledge. By signing this application I am consenting to written comments, letters and or notifications
regarding this application being provided to me or my designated contact via fax and or email. This consent does not
preclude writte r, :•mm. ication from also being sent via first class mail.
I��.� _ 7//r /,
Signa r re of Owner/Agent or Contract Purchaser Date
cief.fg 1 ��/1 gk/ s__ejtzr_ (`/3y) Z95'—.5'V `
Print Name Daytime phone number of Signatory
Required FEES to be paid once the application is deemed complete:
What type of Zoning Map Amendment are you applying for?
Zoning Map Amendment of less than 50 acres $2,688
❑ Zoning Map Amendment of greater than 50 acres $3,763
To be paid after staff review for public notice:
Most applications for a Zoning Map Amendment require at least one public hearing by the Planning Commission and one
public hearing by the Board of Supervisors. Virginia State Code requires that notice for public hearings be made by
publishing a legal advertisement in the newspaper and by mailing letters to adjacent property owners. Therefore,at least two
fees for public notice are required before a Zoning Map Amendment may be heard by the Board of Supervisors.
The total fee for public notice will be provided to the applicant after the final cost is determined and must be paid before
the application is heard by a public body.
> Preparing and mailing or delivering up to fifty(50)notices $215 +actual cost of first-class postage
D Preparing and mailing or delivering each notice after fifty(50) $1.08 for each additional notice+actual
cost of first-class postage
> Legal advertisement(published twice in the newspaper for each public hearing) Actual cost
(averages between$150 and$250)
> Special Exception—provide written justification with application-$457
Other FEES that may apply:
❑ Deferral of scheduled public hearing at applicant's request $194
Resubmittal fees for original Zoning Map Amendment fee of$2,866
❑ First resubmission FREE
❑ Each additional resubmission (TO BE PAID WHEN THE RESUBMISSION IS MADE TO INTAKE STAFF) $1,344
Resubmittal fees for original Special Use Permit fee of$3,763
❑ First resubmission FREE
❑ Each additional resubmission (TO BE PAID WHEN THE RESUBMISSION IS MADE TO INTAKE STAFF) $1,881
The full list of fees can be found in Section 35 of the Albemarle County Zoning Ordinance.
Zoning Map Amendment Application Revised 11/02/2015 Page 4 of 4
CONVENTIONAL DISTRICT
oy
ZONING MAP AMENDMENT CHECKLIST for , 1Y7
TMPs 45-12 and 45-112E - Wood and Von Storch 111110,,
Project Name/Tax Map Parcel Number Nd0
(CONVENTIONAL ZONING DISTRICTS-RA,VR,R-1,R-2,R-4,R-6,R-10,R-15,C-1 CO,HC,LI,HI, DCD)
After the mandatory pre-application meeting,county staff will mark this checklist appropriately so
that it is clear to the applicant the information from Section 33.4(c)that must be submitted with EKE
the official application Name or initials of
staff filling out form
Required for Provided with
application? application
(County Staff) (Applicant) SECTION 33.4(c)
X X
YES NO
A narrative of the project proposal,including its public need or benefit;
A narrative of the proposed project's consistency with the comprehensive plan,
X including the land use plan and the master plan for the applicable development area;
A narrative of the proposed project's impacts on public facilities and public
X infrastructure.
A narrative of the proposed project's impacts on environmental features.
X A narrative of the proffers proposed to address impacts from the proposed project.
One or more maps showing the proposed project's regional context and existing natural
X and manmade physical conditions;
X A conceptual plan showing,as applicable:
1) the street network,including
X ❑ circulation within the project and
X ❑ connections to existing and proposed or planned streets within and outside of
the project;
2) typical cross-sections to show
X ❑ proportions,
X ❑ scale and
X ❑ streetscape/cross-sections/circulation;
CONVENTIONAL DISTRICT ZONING MAP AMENDMENT CHECKLIST 04/2013 Page 1 of 2
rialiall
einallis 3)the$eneral location of
Pedestrian and bicycle faci►it,e
4)building envelopes;
ellaftil
5)parking envelopes;
Walla 6)public Spaces and amenities;
latallial
7)areas to be designated:::oetbon
8 c) onceptual stormwater and/or preservation
ftilrvation areas;
9)conceptual detention facility locations;
grading;
III Other special studies
ilidentified °r documentation
P as l studies
necessary b ,if applicable,
Tri generation information the county on the e,and any other information
• a. a °mmunr y .ee Inn comment form.
• 9 Hi : icaZsta:me;ta 'ZLZ1ayso-155-40.
required by Virginia Code§15.2-222Z1
Please note:There are
additional sub �' - 1 and 24 VAC
mitral requirements outlined onI
n the official application for a Zoning
Y state that, to the Read
this Che klis best y kn
of m 8e, thand Sign Hing Map Amend
.
tis required for knowledge, meet
ap�►ication, e official application submitted contains all information
1 ature marked on
U of person completing this checklist e
.41 ..b.4111 /6 le.' h..,
�� Dat /e 7
t Name number of
AI
�r:
Daytime phone .- --1----5- _,X__.
_. a c,/
Signatory
CONVENTIONAL DISTRICT ZONING
MAP AMENDMrn„- -
X 3)the general location of pedestrian and bicycle facilities;
X 4)building envelopes;
X 5) parking envelopes;
X 6)public spaces and amenities;
v 7)areas to be designated as conservation and/or preservation areas;
X 8)conceptual stormwater detention facility locations;
X 9)conceptual grading;
Other special studies or documentation,if applicable,and any other information
identified as necessary by the county on the pre-application comment form.
X Trip generation information
be advised that a Community Meeting will need to be held wlin 30 days of
Submittal. Contact County staff for more Informa'tton.
A local traffic impact statement as required by Virginia Code§15.2-2222.1 and 24 VAC
X 30-155-40.
Please note:There are additional submittal requirements outlined on the official application for a Zoning Map Amendment.
Read and Sign
hereby state that,to the best of my knowledge,the official application submitted contains all information marked on
this the_,i":s required for application.
'I /if /�
Sig11ature of person completing this checklist Date
74/14‹ e _Org.) —6?)
Print Name Daytime phone number of Signatory
CONVENTIONAL DISTRICT ZONING MAP AMENDMENT CHECKLIST 04/2013 Page 2 of 2