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P/C Meeting
BOS Meeting
APPLICATION FOR CONDITIONAL USE PERMIT
FREDERICK COUNTY, VIRGINIA
1. Applicant (The applicant if the V owner other)
NAME: _�P� G o r.-� to es- 1
ADDRESS: ,h6jP1'-L XROact-, M �'(�e- t9v,,j -;21z,uS-
TELEPHONE ��� -()q 3S'
2. Please list all owners, occupants (adult individuals as well
as any entities occupying the property), or parties in the
interest of the property:
ja n e- n e is -o -.-A.. rY, e t ma I I N
3. The property is located at: (please give exact directions and
include the route number of your road or street)
I
q H q rte, d a a, C,a- 'p- )-s & r'o ty e--
be,S
The property has
depth of
(Please be exact)
a road frontage of feet and a
feet and consists of 1.0 acres.
5. The property is owned by �y��,/�� (� Dr,�..oGi���� s L LG as
evidenced by deed from recorded
(previous owner)
in deed book no. on page , as recorded in the
records of the Clerk of the Circuit Court, County of
Frederick. iiDPi 67� tqeea( a--p,Gh
6. Tax (Parcel) Identification (I. D.) No.
'Magisterial District
Current Zoning
7. Adjoining Property:
USE
North
East
South
West
ZONING
8. The type of use proposed is (consult with the Planning Dept. before completing)
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9. It is proposed that the following buildings will be constructed:
10. The following are all of the individuals, firms, or corporations owning property adjacent
to both sides and rear and in front of (across street from) the property where the requested
use will be conducted. (Continue on back if necessary.) These people will be notified by
mail of this application:
NAME, 4�0�� - P� �Lp{o-u�ADDRESS .1 �t2s - " L a
PROPERTY ID# J
In CA,--, e,6 (-e-,,;—? V�
NAME a , e,1(o[v-�iDDRESS 13 S o,-, d -L /-a
PROPERTY ID# fg 3 — a ig W ` , CIA e, S f n- "V:2
NAME
ADDRESS
PROPERTY ID#
NAME
ADDRESS
PROPERTY ID#
NAME
ADDRESS
PROPERTY ID#
NAME
ADDRESS
PROPERTY ID#
11. Please use this page for your sketch of the property. Show proposed and/or existing
structures on the property, including measurements to all property lines.
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12. Additional comments, if any:
I (we), the undersigned, do hereby respectfully make application and petition the governing body
of Frederick County, Virginia to allow the use described in this application. I understand that the
sign issued to me when this application is submitted must be placed at the front property line at
least seven (7) days prior to the first public hearing and maintained so as to be visible until after
the Board of Supervisors' public hearing. Your application for a Conditional Use Permit
authorizes any member of the Frederick County Planning Commission, Board of Supervisors or
Planning and Development Department to inspect your property where the proposed use will be
conducted.
Signature of Applicant J A h e, sem-- 5 ka - / / f -p 6 0,,�� r,_ �,�5 LL e,
Signature of Owner j at, w --
Owners' Mailing Address C �� P -L /-)-) ,` �% ... V -P -- sS
Owners' Telephone No. ,:(A p ,S 632 - &U-<
TO BE COMPLETED BY THE ZONING ADMINISTRATOR:
USE CODE:
RENEWAL DATE: