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*For office t~''' only *
*CASE NO. "? '~ '~ "~ C
- ,
*REVIEW BY P.C. ·
:.: ~ ~..;'" APPLICATION FOR AMENDMENT TO THE
CHESTERFIELD COUNTY ZONING ORDINANCE
T~.e following _information is to be _typed _or printed
~AME OF PRESENT OWNER OF PROPERTY ON WHICH THIS REQUEST WILL
)CCUR: _,
~AILING ADDRESS:
!ELEPHONE NO.:
iE APPLICANT IS NOT THE OWNER OF THE PROPERTY IN QUESTION,
IN: (Copy of pending contract or option agreement shall
tached hereto and made a part of this application.)
LOCATION OF PROPERTY IN QUESTION
(~)llowing information to be obtained by the applicant
from the Office of the County Assessor)
M~GISTERIAL DISTRICT C£~-~/F~z~ B) TAX MAP NO.~ ~ ~
S~C. NO. D) SUBDIVISION NO. E) BLOCK NO.
'0
· F THIS PROPERTY SHALL BE ATTACHED HERETO AND MADE A PART
:S APPLICATION SHOWING THE FOLLOWING:
,OCATION BY REFERENCE TO NEAREST ROAD INTERSECTION
)IMENSIONS OF SITE
(PAGE 1)
THE
REC~
5) STA'.
6) STAT
THE
7) STAT]
THE
8) EXIS~
PETITIONER REQUESTS THAT THE ZONING ORDINANCE BE AMENDED TO
ASSIFY THIS PROPERTY FROM ,,~,f'~¢~,~r~,~c
NO./NA~ ~ -
E THE REASON FOR THIS REQUEST:
TO ~F~, - ,,~'- Z-
NO./N'AME -
HOW THIS REQUEST WILL NOT BE MATERIALLY DETRIMENTAL TO
%DJACENT PROPERTY OWNERS OR THE SURROUNDING NEIGHBORHOOD:
ANY EXISTING USE PERMIT OR VARIANCE GRANTED PREVIOUSLY ON
'ARCEL IN QUESTION:
ING LAND USE:
(PAGE 2)
9)
GIV~ NAMES OF ALL OWNERS ADJACENT, ACROSS THE ROAD OR HIGHWAY
AND FACING THE PROPERTY AND ANY OWNERS ACROSS ANY RAILROAD RIGHT
OF kAY FROM SUCH PROPERTY. IN THE EVENT~THE PROPERTY AFFECTED
IS SITUATED AT OR WITHIN 100 FEET ON THE INTERSECTION OF ANY
TWO DR MORE ROADS OR ~HIGHWAYS, AT OR WITHIN ONE HUNDRED FEET
OF ~E INTERSECTION OF ANY ROAD OR HIGHWAY WITH A RAILROAD RIGHT-
OF-W
·-.THE
OWNE
A)
B)
¢)
D)
~Y OR AT OR WITHIN ONE HUNDRED FEET OF THE INTERSECTION OF
{IGHTS-OF-WAY OF ANY TWO RAILROADS, GIVE NAMES OF PROPERTY
{S AT ALL CORNERS OF ANY SUCH INTERSECTION.
>ROPERTY OWNER'S NAME:
~AILING ADDRESS:
?AX MAP NO.: ~3
~LOCK NO.:
SEC. N0.: ~ SUBDIVISION NO.:
LOT OR PARCEL NO.: d~7
ROPERTY OWNER'S NAME:
'AX MAP NO.:
,LOCK NO.:
SEC. NO.:~ S~DIVISION NO.: LOT OR PARCEL NO.:
ROPERTY OWNER'S NA~: .~/o .ffo~o~ ~,,
AILING ADDRESS: ~Z~O ~/~ ~
~X ~P ~0.: ~ SEC. ~0.: ~ S~BDITiSlO~ ~0 :
LOCK ~0.: BOT OR PARCEL NO.:
ROPERTY OWNER'S NAME: F,~-~-~' b~. ~
AILING ADDRESS: ~-
~X MAP NO.: ~_~ SEC. NO.: ~ SUBDIVISION' NO.:
[,OCK NO.: LOT OR PARCEL NO.:
(P6GE 3)
E)
F)
G)
H)
I)
J)
PROi
MAIi
TAX MAP NO.: ~3-7
BLO( K NO.:
PRO] ERTY OWNER'S NAME
MAIl ING ADDRESS:
TAX MAP NO.: ~3
BLO( K NO.:
PRO ERTY OWNER'S NAME
MAIl ING ADDRESS:
TAX ~AP NO.:
BLO( .{ NO.:
PRO] ZRTY OWNER'S NAME:
MAIl lNG ADDRESS:
TAX RAP NO.:
BLOC NO.:
PROP'. IRTY OWNER' S NAME:
MAILi iNG ADDRESS:
TAX [AP NO.:
BLOC] NO.:
PROP RTY OWNER' S NAME:
MAIL] NG ADDRESS:
TAX 5AP NO.:
BLOCM NO,:
,ING ADDRESS: ~;-~_ ~, C/~ _~.,,~/"'Z=,,~./=Z~-L~ //'~1 _, Z3~F~gz-~
SEC. NO. :...~ SUBDIVISION NO.:
LOT OR PARCEL NO.: ~'-~
SEC. NO.: ~ SUBDIVISION NO.:
LOT OR PARCEL NO.: ~-~
SEC. NO.: SUBDIVISION NO.:
LOT OR PARCEL NO.:
SEC. NO.:
SUBDIVISION NO.:
LOT OR PARCEL NO.:
SEC. NO.:
SUBDIVISION NO.:
LOT OR PARCEL NO.:
SEC. NO.: SUBDIVISION NO.:
LOT OR PARCEL NO.:
(PAGE
lO)
TH!
TH
TO
II~
AN!
/
APPLICANT HEREWITH DEPOSITS THE SUM OF TWENTY DOLLARS
~) ATTACHED TO THIS APPLICATION, TO PAY THE COST OF
ERTISING NOTICE OF THE HEARING OF SAID BOARD TO ACT ON
S REQUEST. CHECK OR MONEY ORDER MUST BE MADE PAYABLE
TREASU~ER~ COUNTY OF CHESTERFIELD.
SUf
E HEREBY DEPOSE AND SAY THAT ALL OF THE ABOVE STATEMENTS
THE STATEMENTS CONTAINED IN ANY EXHIBITS TRANSMITTED ARE
Ee
.~_GNKTURE OF KPPL~
(Same name as used in
page 1.)
TO BEFORE ME THIS~)c~'m DAY OF~Q~__197.~
SCRIBED
AND
SWORN
coMMissioN EXPIRES l s.
-- ~ NOTARY
(PAGE 5)
tM THE: CLOVEI~ HILL DIGT'~ICT OF" CFIEGTE:~FIELFP CO, VA.
.~1¢:-