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72-28c*For office *CASE NO. ,, *REVIEW BY P. C. , APPLICATION FOR AMENDMENT TO THE CHESTERFIELD COUNTY ZONING ORDINANCE 1) The followin~ information is to be typed or printed . ^) NAME OF APPLICANT:. D) NA~ OF PRESENT OWNER OP PROPERTY ON WHIDH THIS ~q~ST WILL occuR: E) HAILING ADDRESS: 2) IF THE APPLICANT IS NOT THE OWNER OF THE PROPERTY IN QUESTION, EXPLAIN: (Copy of pending contract or option agreement shall be attached hereto and made a part of this application.) 3) LOCATION OF PROPERTY IN QUESTION (Following information to be obtained by the applicant from the Office of the County Assessor) A) MAGISTERIAL DISTRIcTCJove-~;II B) TAX MAP NO. I'1 C) SEC. NO. ] ~ D) SUBDIVISION NO. E) BLOCK NO. F) LOT OR PARCEL NO. 6 ~%~ G) STREET ADDRESS t0600 A PLAT OF THIS PROPERTY SHALL BE ATTACHED HERETO AND MADE A PART OF THIS APPLICATION SHOWING THE FOLLOWING: LOCATION BY REFERENCE TO NEAREST ROAD INTERSECTION DIMENSIONS OF SITE ~/%- 7- ~--~ ~. ~- L~-~' (PAGE 1) 4) 5) ~C~,ASSIFY THIS PROPERTY FROM ~-~ TO ~~ m NO./NAME NO./NAME STATE THE REASON FOR THIS REQUEST: 6) STATE HOW THIS REQUEST WILL NOT BE MATERIALLY DETRIMENTAL TO THE ADJACENT PROPERTY OWNERS OR THE SURROUNDING NEIGHBORHOOD: " / / {] * . 7) STATE ANY EXISTING USE PERMIT OR VARIANCE GRANTED PREVIOUSLY ON THE PARCEL IN QUESTION: 8) EXISTING LAND USE: (PAGE 2) 9) GIVE NAMES OF ALL OWNERS ADJACENT, ACROSS THE ROAD OR HIGHWAY AND FACING THE PROPERTY AND ANY OWNERS ACROSS ANY RAILROAD RIGHT_ OF WAY FROM SUCH PROPERTY. IN THE EVENT THE PROPERTY AFFECTED IS SITUATED AT OR WITHIN 100 FEET ON THE INTERSECTION OF ANY TWO OR MORE ROADS OR HIGHWAYS, AT OR WITHIN ONE HUNDRED FEET OF THE INTERSECTION OF ANY ROAD OR HIGHWAY WITH A RAILROAD RIGHT- OF-WAY OR AT OR WITHIN ONE HUNDRED FEET OF THE INTERSECTION OF THE RIGHTS-OF-WAY OF ANY TWO RAILROADS, GIVE NAMES OF PROPERTY OWNERS AT ALL CORNERS OF ANY SUCH INTERSECTION. A) PROPERTY OWNER'S NAME: J~-D~-g TAX MAP NO.: ;1, , SEC. NO.: ~[ SUBDIVISION NO.: BLOCK NO.: LOT OR PARCEL NO.: B) MAILING ADDRESS: ~ ~ ~ I ~: c:[.. [C~J- k l ~1-/',/' /~l'% TAX MAP NO.: 17 SEC. NO.: /! SUBDIVISION NO.: BLOCK NO.: LOT OR PARCEL NO.: ~ c) PROPERTY OWNER'S NAME: ,~ Akl ~.~; ~ {~- ~r(~ ~ MAILING ADDRESS: . ,fO ~'0 ~ ~. ~a [~1 ~ TAX MAP NO.: ~ SEC. NO.:~ SUBDIVISION BLOCK NO.: LOT OR PARCEL NO.: / D) PROPERTY OWNER'S NAME: MAILING ADDRESS: TAX MAP NO.: I3 BLOC]{ NO.: SEC. NO.: '1~ SUBDIVISION NO.: LOT OR PARCEL NO.: (PAGE 3) 10) THE APPLICANT HE,WITH DEPOSITS THE SUM OF TWENTY DOLLARS ($20.00) ATTACHED TO THIS APPLICATION, TO PAY THE COST OF ADVERTISING NOTICE OF THE HEARING OF SAID BOARD TO ACT ON THIS REQUEST. CHECK OR MONEY ORDER MUST BE MADE PAYABLE TO: T~AS~RER~ COUNTY OF CHESTERFIELD. I/WE HEREBY DEPOSE AND SAY THAT ALL OF THE ABOVE STATEMENTS AND THE STATEMENTS CONTAINED IN ANY EXHIBITS TRANSMITTED ARE TRUE. tL~Same ~s used in item p&ge 1. ) SUBSCRIBED AND SWORN TO BEFORE ME THIS ~_-5z- DAY OF J,~,7,~ 197~- ' ' NOTARY - (PAGE 5)