SP202200029 Application 2023-03-06•
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APPLICATION FOR A SPECIAL EXCEPTION
0 Request for a waiver, modification, variation or ❑ Variation to a previously approved Planned
substitution permitted by Chapter 18 Development rezoning application plan or
Code of Development
OR
❑ Relief from a condition of approval
Provide the following
1 copy of a written request specifying the
section or sections being requested to be
waived, modified, varied or substituted, and
any other exhibit documents stating the reasons
for the request and addressing the applicable
findings of the section authorized to be waived,
modified, varied or substituted.
Provide the following
1 copy of the existing approved plan
illustrating the area where the change is
requested or the applicable section(s) or
the Code of Development. Provide a
graphic representation of the requested
change.
1 copy of a written request specifying the
provision of the plan, code or standard for
which the variation is sought, and state the
reason for the requested variation.
FEE = 523.12
Application $503 + Technology surcharge $20.12
Project Name : Crozet Mobile Home
Current Assigned Application Number (HS, HO, CLE, SDP, SP or ZMA)SP2022-29
Tax map and parcel(s): 56-48
Applicant / Contact Person Kelsey Schlein, Shimp Engineering, P.C.
Address 912 E High Street
Daytime Phone# (434 ) 227-514o Fax# (
Owner of Record Crozet MHC LLC
Address 703 E Jefferson Street
Daytime Phone# (
Fax# (
City Charlottesville
City Charlottesville
State VA Zip 22902
Email kelsey@shimp-engineering.com
Email
State VA Zip 22902
County of Albemarle
Community Development Department
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2021
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•
APPLICATION FOR A SPECIAL EXCEPTION
APPLICATION SIGNATURE PAGE
If the person signing the application is someone other than the owner of record, then a signed copy of the
"CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE
LANDOWNER" form must be provided in addition to the signing the application below. (page 3)
Owner/Applicant Must Read and Sign
By signing this application, I hereby certify that I own the subject property, or have the legal power to act
on behalf of the owner of the subject parcel(s) listed in County Records. 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 such written communication from also being sent via first class mail.
Ilew
Signature of Owner / Agent / Contract Purchaser
Rachel Moon
Print Name
FOR OFFICE USE ONLY APPLICATION#
By who?
Receipt #
03/06/2023
434-227-5140
Daytime phone number of Signatory
Fee Amount S Date Paid
Ck#
By.
Revised 7/1/2021
9111k ■■'m•
APPLICATION FOR A SPECIAL EXCEPTION
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany this zoning application if the application is not signed by the owner of the property.
I certify that notice of the application for, SP2022-29 Crozet Mobile Home
[Name of the application type
was provided to Crozet MHC LLC
[Name(s) of the record owners of the parcel]
the owner of record of Tax Map and Parcel Number 05600-00-00-04800
by delivering a copy of the application in the manner identified below:
nHand delivery of a copy of the application to Tim Henderson, Manager
[Name of the record owner if the record owner is a person; if
the owner of record is an entity, identify the recipient of the
record and the recipients title or office for that entity]
on 03/06/2023
Date
EMailing a copy of the application to
[Name of the record owner if the record owner is a person; if
the owner of record is an entity, identify the recipient of the
record and the recipients title or office for that entity]
on
Date
to the following address
[Address; written notice mailed to the owner at the
last known address of the owner as shown on the
current real estate tax assessment books or current real
estate tax assessment records satisfies this
requirement].
Signature of Applicant
Print Applicant Name
Date
Revised 7/1/2021