HomeMy WebLinkAbout16-04 Courtyard By Marriott Gainesboro - BackfileSubdivision Checklist
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1.
2.
Comment sheets from the following agencies, along with any marked copies of the plan:
VDOT
Sanitation Authority
Inspections Department
Fire Marshal
City of Winchester
Health Department
Parks & Recreation
County Engineer
✓ One copy of the subdivision application
/ /0 Application received.
d
/o 0 Fee paid (amount: $d
milt d G� )
b Information entered in d-BASE and Reference Manual
D - 0k t_� File given to Renee' to add to Application Action Summary
Plat(s) signed by Subdivision Administrator
Approval letter to applicant/agent
GIS (Road Name
Review)
l ! �� Copy of final subdivision plat(s) [with signatures] made and given to Mapping
and Graphics Manager for structure numbering assignment
1 I I �� Updated d-BASE and Reference Manual
g • U ile given to Renee'- to update Application Action Summary
Final plat(s) submitted with review agency signatures along with:
-- -- --------Recorded deed of dedication
Bond estimate (if required) $
0 \Operations Manual\subdivision.A
Revised 6/24/02
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BY � .
6
KUYKENDALL, JOHNSTON,
MCKEE & BUTLER, P.L. C.
112 SOUTH CAMERON STREET
P. O. DRAWER 2097
WINCHESTER, VIRGINIA 22604-1297
(540)662-3486
Facsimile (540) 722-3787
E-Mail: bmblaw@adelphia.net
PETER K. McKEE (1934-1967)
BENJAMIN M.BUTLER
STEPHEN G. BUTLER
TRANSMITTAL LETTER
August 16, 2004
Mark Cheran
Frederick County Planning Dept.
107 N. Kent Street
Winchester, VA 22601
J. SLOAN KUYKENDALL (1906-1995)
J. SLOAN KUYKENDALL, III
EDWIN B. YOST
File No. 11858
Quantity
Document Name
Shipment
Method
Comment
1
Copy of Recorded Deed of Dedication
USPS
Winchester Medical Ctr.
If you have any questions regarding the enclosed documents, please feel free to contact me.
Very truly yours,
MC E & BUTLER
enjamin M. Butler
BMB:vg
040016054 a
N)
mos. I I �
THIS DEED OF DEDICATION made and dated this 12' day of August 2004,
W
i
v
a Virginia Corporation company,
hereinafter called Declarant.
WHEREAS, the Declarant is the owner of a certain tract of land containing
101.9214 acres lying and being situate in Gainesboro Magisterial District, Frederick
County, Virginia, (Frederick County Tax Map No. 53-((A))-68) and more particularly
shown on the survey drawn by Randy A. Stowers, L.S., dated August 12, 2004 attached
hereto and by this reference made apart hereof as if set out in full; AND BEING the same
property conveyed to Winchester Medical Center, Inc. by Deed recorded in the Clerk's
Office of the Circuit Court of Frederick County, Virginia as Instrument No. 00-00012098;
and,
WHEREAS, it is the desire of the Declarant to subdivide the same into a
3.9481 acre tract and a 97.9733 acre tract as shown on the plat drawn by Randy A.
Stowers, dated August 12, 2004 attached hereto and by this reference made apart hereof
as if set out in full;
NOW, THEREFORE, this Deed of Dedication witnesseth:
That for and in consideration of the premises and the benefits that will accrue by
reason of this Dedication, the Declarant does hereby subdivide, that certain tract of land
shown on the plat of survey drawn by Randy A. Stowers, L. S., dated August 12, 2004, into
a tract of land containing 3.9481 acres and the remainder tract of 97.9733 acres; AND
BEING the same land conveyed to Winchester Medical Center, Inc., by Deed of record
in the Clerk's Office of the Circuit Court of Frederick County, Virginia, as Instrument
No. 00-00012098.
Page 1 of 2
Q
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The Declarant does further dedicate as a landscape buffer that certain 50-foot-wide
landscape buffer shown on the aforesaid plat drawn by Randy A. Stowers attached hereto.
The Declarant does further dedicate a certain 50-foot-wide access easement extending
from the 3.9481 acre tract through the remainder tract of 97.9733 acre tract as shown on
the plat of survey drawn by Randy A. Stowers to a future street designated "future
Periwinkle Drive" (but known as Petticoat Gap Lane) on the plat drawn by Randy A.
Stowers attached hereto and by this reference made a part hereof as if set out in full.
The dedication and subdivision of the land as shown on the aforesaid attached plat
is with the free consent and in accordance with the desire of the undersigned Declarant
and is in conformity with the provisions of the "Virginia Land Subdivision Act and the
Frederick County Subdivision Ordinance".
WITNESS the following signature and seal:
WINCHESTER MEDICAL CENTER, INC.
By:
)
C. Douglas R , Senior Vice President
STATE OF VIRGINIA
CITY OF WINCHESTER, TO WIT:
I, � , a Notary Public in and for the State and jurisdiction
aforesaid, do hereby certify that C. Douglas Rosen is the Senior Vice President for Winchester
Medical Center, Inc., whose name is signed to the foregoing Deed of Dedication, dated
August 12, 2004, has personally appeared before me and acknowledged the same in my State and
jurisdiction aforesaid.
Given under my hand this day of August, 2004.
My Commission expires �a rv5^E
Notary PubTirc a
PJJBOr31
-
11858VHS\AADEEDdDedication.wpd '.%,` � •••..•••.
Page 2 of 2
Af IJKUVLU bT:
SUBDIVISION ADMINISTRATOR DATE %e Ad e `�'
OWNER'S CERTIFICATION:
THE ABOVE AND FOREGOING MINOR SUBDIVISION OF THE PROPERTY OF
WINCHESTER MEDICAL CENTER, INC. AS APPEARS ON THE ACCOMPANYING PLAT, IS
WITH THE FREE CON5FNT AND ACCORDANCE WITH THE DESIRES OF THE
UNDE�SIG D �,ROPRI IRS AND TRUSTEES, IF ANY,
BY: ��V/
NOTARY PUBLIC
STATE'OF tiAJa'
Cl:TY/COUNTY :CIF tAJ- AJr--b 1!18 6—/L
THEE FOREGQhNG INSTRUMENT WAS ACKNOWLEDGED BEFORE ME ON c u2 BY
0- - If'11A ►# 1,6 < Ee-6A9-AJ DATE
& e f MY COMMISSION EXPIRES -/mac 09-yig&J-P I ,c 0
TARY PUBLIC)
NOTES:
1. THIS PLAT HAS BEEN PREPARED WITHOUT THE BENEFIT OF A TITLE
REPORT AND DOES NOT THEREFORE NECESSARILY INDICATE ALL
ENCUMBRANCES AND RESTRICTIVE COVENANTS ON THE PROPERTY.
2. THE EXISTENCE OF VEGETATED OR TIDAL WETLANDS WAS NEITHER
INVESTIGATED NOR CONFIRMED DURING THE PERFORMANCE OF THIS
SURVEY BY THIS FIRM.
13, ALL PROPERTY CORNERS TO BE SET IN ACCORDANCE WITH LOCAL I
ORDINANCES.
CURVE TABLE
3
CURVE
RADIUS
DELTA
LENGTH
TANGENT
BEARING
CHORD
Cl
1372.40
19*00,00"
455.11
229.66
N39'03'58"E
453.02
C2
650,00
18'07'25"
205.61
103.67
S80'40'00"E
204.75
C3
300.00
22'33'31"
118.12
59.83
N11'33'02" E
117.35
SURVEYOR'S CERTIFICATION
I, RANDY A. STOWERS, A DULY LICENSED LAND SURVEYOR IN
THE COMMONWEALTH OF VIRGINIA, DO HEREBY CERTIFY, TO
THE BEST OF MY KNOWLEDGE AN BELIEF, THAT THE
PROPERTY IDENTIFIED HEREON AS T.M. # 53—.((A))-68 IS
THE SAME PROPERTY CONVEYED TO WINCHESTER MEDICAL
CENTER, INC. BY DEED RECORDED AT INSTRUMENT # PLAT SHOWING
0000012098 AMONG THE LAND RECORDS OF FREDERICK SUBDIVISION
COUNTY, VIRGINIA. OF THE PROPERTY OF
TH OF
WINCHESTER MEDICAL CENTER, INC.
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INST.# 000012098
GAINESBORO MAGISTERIAL DISTRICT
FREDERICK COUNTY, VIRGINIA
SCALE: AS NOTED DATE: JULY 27, 2004
RANl1� A. ST
gilbert w. Clifford & associates
No. 002342
A DIVISION of
pglz_ay
PATTON HARRIS RUST & ASSOCIATES
A PROFESSIONAL CORPORATION
^I Off,
CONSULTING ENGINEERING — LAND SURVEYING — PLANNING
117 E. PICCADILLY STREET, WINCHESTER, VIRGINIA 22601
(540) 667-2139 SHEET 1 OF
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WINCHESTER MEDICAL CENTER, INC.
INST.# 000012098
GAF E BORODERIC MAGISTERIAL DISTRICT
FREDERICK COUNTY, VIRGINIA
SCALE: 1" 200' DATE. JULY 27, 2004
gilbert w. Clifford & associates
A DIVISION OF
PATTON HARRIS RUST & ASSOCIATES
A PROFESSIONAL CORPORATION
NSULTING ENGINEERING - LAND SURVEYING - PLANNING
7 E. PICCADILLY STREET, WINCHESTER,VIRGINIA 22601
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FRUIT HILL ORCHARD, INC.
T.M. 53—((A))-69
D.B. 296, PG. 302
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tiTH OF WINCHESTER MEDICAL CENTER, INC.
�Q► pj INST.# 000012098
1 "=200 ' GAINESBORO MAGISTERIAL DISTRICT
FREDERICK COUNTY, VIRGINIA
SCALE: 1" - 200' DATE: JULY 27. 2004
v Y A. STONERS a gilbert w. Clifford & associates
No. 002342 A DIVISION OF
ev /Z -o f/ PATTON HARRIS RUST & ASSOCIATES
A PROFESSIONAL CORPORATION
61URVr'' 4, CONSULTING ENGINEERING - LAND SURVEYING - PLANNING
117 E. PICCADILLY STREET, WINCHESTER, VIRGINIA 22601
(540) 667-2139 SHEET 3 OF 7
1. _ - OWNER'S TABULATION:
a
T.M. 53-((A))-76
ROBERT B. JOHNSON
D.B. 586, PG. 878
ZONE: RA, USE: RES.
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T.M. 53-((A))-73
PAGE F. &
ELVA HUFFMAN
D.B. 65, PG. 509
ZONE: RA, USE: RES.
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T.M. 53-((A))-75
NANCY RENNER JOHNSON
D.B. 819, PG. 552
ZONE: RA, USE: RES.
2((T.M. 53A))-A
FRUIT HILL ORCHARD, INC.
D.B. 848, PG. 1208
ZONE: RA. USE: RES.
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T.M. 53-((A))-74
CAROLYN R, TURNER
D.B. 938, PG, 150
ZONE: RA, USE: RES.
6
P/O T.M. 52-((A))-B
WINCHESTER WAREHOUSING, INC.
INST. #030016328
ZONE: B2, USE: VACANT
s FRUIT HILL ORCHARD, INC. \
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D.B. 296, PG. 302 5�6�11E
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PLAT SHOWING
0 200 400 SUBDIVISION
B� OF THE PROPERTY OF
Z,TH OF WINCHESTER MEDICAL CENTER, INC.
INST.# 000012098
1 "-200' GAINESBORO MAGISTERIAL DISTRICT
O FREDERICK COUNTY, VIRGINIA
SCALE: 1" = 200' DATE: JULY 27, 2004
v Y A. STOVERS y gilbert w. Clifford & associates
NO. 002342 A DIVISION OF
PATTON HARRIS RUST & ASSOCIATES
A PROFESSIONAL CORPORATION
CONSULTING ENGINEERING —LAND SURVEYING —PLANNING
117 E. PICCADILLY STREET, WINCHESTER, VIRGINIA 22601
(540) 667-2139 CUCCT d nr
REZONING REQUEST PROFFER c�
Property Identification Number 53-((A))-68 CD
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WINCHESTER MEDICAL CENTER
"West Campus"
Preliminary Matters
Pursuant to Section 15.1 - 491.1 et. seq., of the code of Virginia, 1950, as amended, and the
provisions of the Frederick County Zoning Ordinance with respect to conditional zoning, the
undersigned applicant hereby proffers that in the event the Board of Supervisors of Frederick
County, Virginia, shall approve Rezoning Application # for the rezoning of 51.9676 acres
from Rural Area (RA) Zoning District to the Medical Services (MS) Zoning District, development
of the subject property shall be done in conformity with the terms and conditions set forth herein,
except to the extent that such terms and conditions may be subsequently amended or revised by the
applicant and such be approved by the Frederick County Board of Supervisors in accordance with
Virginia law. Also within this tax parcel is 50.0540 acres zoned B-2 which will remain B-2 after
rezoning. The proffers which exist on the 50.0540 acre parcel have been included in this proffer
statement and together with the added proffers constitute the complete proffer for the entire tract of
102.0216 acres. Should this petition for rezoning not be approved by the Board of Supervisors
then the existing proffer statement for the B-2 tract will remain in effect and these proffers shall be
deemed withdrawn and of no effect whatsoever. These proffers shall be binding upon the applicant
and their legal successor or assigns.
General Development Plan
The development of the subject property, and the submission of any Master Development Plan
shall be in conformance with all pertinent County regulations and shall be in substantial conformity
with the Generalized Development Plan, dated September 2002, sheets 5 of 6 and 6 of 6, which are
attached hereto and incorporated herein by reference.
Street Improvements
The Applicant shall design and construct all roads on the subject property consistent with the
County's adopted Round Hill Land Use Plan for the area, and according to uniform standards
established by the Virginia Department of Transportation (VDOT), and as may be provided in these
proffers as illustrated on the Generalized Development Plan which is attached hereto and
incorporated herein by reference.
1. On U.S. Route 50 at the intersection of Route 1317, a 200 feet left turn lane for eastbound traffic
will be provided. (#1)
2. On U.S. Route 50, an acceleration/deceleration lane will be added across the entire U.S. Route 50
frontage of the site, and the only exit on U.S. Route 50 will be located at the Route 1317
intersection. Curb and gutter will be provided along the entire frontage. (#2)
3. At the VA Route 1317 intersection, traffic leaving the site will be provided two left turn lanes,
(on left turn with through movement) and one right turn lane. (#3)
4. Lanes will be added to the VA Route 37 exit ramps to allow dedicated right and left turn lanes
(#4) as follows:
PLAT SHOWING
0 200 400 SUBDIVISION
OF THE PROPERTY OF
WINCHESTER MEDICAL -CENTER, INC.
�I�.tiTH aF lrr INST.# 000012098
1 =200 GAINESBORO MAGISTERIAL DISTRICT
O FREDERICK COUNTY, VIRGINIA
SCALE: 1" = 200' DATE: JULY 27. 2004
v Y A. STONERS � gilbert w. clifford & associates
No. 002342 A DIVISION OF
PATTON HARRIS RUST & ASSOCIATES
A PROFESSIONAL CORPORATION
CONSULTING
17 E.PICCADILLY STREET. WINCHESTER. PLANNING
VIRGINIA 22601
'`'�Np (540) 667-2139 SHEET 5 OF
- At U.S. Route 50NA Route 37 western signal, Southbound right turn - 200 feet with transition to
provide full 2 lanes at intersection.
- At U.S. Route 50/VA Route 37 eastern signal, Northbound left turn - 200 feet with transition to
provide 3 lanes at intersection including a dedicated left, a left with through and right turn lanes.
Co
5. A traffic signal will be provided at U.S. Route 50 and VA Route 1317 intersection. (#5) CD
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6. An additional left turn lane will be provided on U.S. Route 50 for the eastbound traffic at the 1TV
Route 50/VA Route 37 eastern signal. (#6)
7. A major collector road, 1800 feet in length and 5 lanes wide, with 80 feetstrightL right of way.
(#7)
Transportation items 1 through 6 shall be constructed during the initial site development phase of
the project and shall be either complete or bonded for completion prior to issuance of the first
occupancy permit.
The applicant shall limit entrance connections onto U.S. Route 50 to two points as shown on GDP.
The applicant shall prepare a traffic generation estimate for uses established by the Site
Development Plan to be submitted for initial construction approval to the County. The combined
trip generation (ADT) shall not exceed 14,000 TPD (average weekday volume) without further
approval by the County. The actual trip generation from the project shall be determined by the
Winchester Medical Center Management annually, from data collected in May and with results due
on July 1 of each year, and be available for review as individual site plans and subdivisions for
future uses are submitted for review by VDOT and the County. The combined traffic impact from
the 102 acre site is not to exceed 14,000 TPD (average weekday volume) when current actual
counts and proposed counts are added for cumulative total. If the cumulative total for any site plan
at WMC causes the total to exceed 14,000 TPD then it is agreed that the applicant shall not file
additional site plan application until the County is satisfied that adequate and manageable levels of
service will exist on state or internal site roadways. The SIC code system and the ITE shall be
utilized for the subject projections. The applicant shall perform an updated TIA of the project
intersection on U.S. Route 50 and of the Route 50/Route 37 interchange when traffic generation
from the 102 acre site reaches 14,000 TPD (average weekday volume). The County may revise this
14,000 TPD limit upward, without modification of this proffer agreement, should results of the TIA
show that additional loading is appropriate.
Landscape Design Features
The development of the subject property, and the submission of any Master Development Plan
shall include the following landscape design feature provided in these proffers and as illustrated on
the Concept Plan revised 3/4/03 which is attached hereto and incorporated herein by reference.
1. A fifty foot (50') landscaped buffer along the US Route 50 frontage portion of the site. (0).
Internal parking, travel ways and commercial structures shall not extend closer than 50' to front
right of way line on U.S. Route 50. An illustrative detail is attached to this proffer for the purpose
of establishing a standard of quality to be implemented upon final design. (See ID "A").
2. A landscaped green area along the north side of the main entrance. (See ID "A") (#9)
0 200 400
TH 0� yr
1"=200' '04
GlZ
O A. STOMS
0 No.002342
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`AND„�t04'
PLAT SHOWING
SUBDIVISION
OF THE PROPERTY OF
WINCHESTER MEDICAL CENTER, INC.
INST.# 000012098
GAINESBORO MAGISTERIAL DISTRICT
FREDERICK COUNTY, VIRGINIA
SCALE: 1" = 200' DATE: JULY 27. 2004
y gilbert w. Clifford & associates
A DIVISION OF
PATTON HARRIS RUST & ASSOCIATES
A PROFESSIONAL CORPORATION
CONSULTING ENGINEERING - LAND SURVEYING - PLANNING
117 E. PICCADILLY STREET, WINCHESTER, VIRGINIA 22601
(540) 667-2139 SHEET 6 OF 7
3. A landscaped, open, greenyvisual focal link and park located at a "roundabout" (#10). An
illustrative example (ID "B") is attached to this proffer for the purpose of establishing a standard of
quality to be implemented upon final design. C✓+
CZ)
On Site Development C
The Winchester Medical Center shall establish an Architectural Review Committee (ARC) to
review all planning within the 104 acre site to insure conformance with the standard of quality
described in the Master Development Plan and Covenants. In general, project covenants shall
establish a standard of quality for structures and site design as follows:
1. Materials utilized for the facades of the buildings shall include but not be limited to concrete
masonry units (CMU) brick, architectural block, dryvit, or other simulated stucco (EFIS), real or
simulated wood and/or glass.
2. All building within the development on the property shall be constructed using compatible
architectural style and materials, and signage for such buildings shall be of a similar style and
materials.
3. All building within the property shall be developed as a cohesive entity, ensuring that building
placement, architectural treatmestrightLnt, parking lot lighting, landscaping, trash disposal,
vehicular and pedestrian circulation and other development elements work together functionally
and aesthetically.
4. A single monument type sign shall be utilized near the project entrance to describe internal
features. Sign height shall be limited to 20' within 50' landscape area along U.S. Route 50.
Individual signs to be allowed per ordinance requirements to announce individual uses. On
building signage to be the preferred sign type for individual uses. No other signs shall be located
within 50' buffer area.
The Applicant shall record and include in each deed as well as provide Frederick County with a
complete set of Covenants and Restrictions pursuant to site design developed and approved by
Frederick County at the time of master plan.
Property owners shall be notified of conditions relating to adjoining active agricultural operations.
Monetary Contribution to Offset Impact of Development
The undersigned, who owns the above described property hereby voluntarily proffers that if the
Board of Supervisors for the County of Frederick, Virginia approves the rezoning for the 51.9676
acre tract 2, lying on the north side of U.S. Route 50 in the Gainesboro Magisterial District of
Frederick County, Virginia from RA; to 1VI and approves the. revised planning for the 50.0540 acre
.
tract 1, the undersigned will pay to Frederick County for' the Round Hill Fire and Rescue Company
the sum of $25,000.00, the Sheriff s Office the sum of $5,000.00 and the Administration Building
the sum of $5,000.00 for a total payment of.$35 000.00 at the time the first building permit on the
102.0216 acre tract 's issued:
The conditions proffered above shall be; binding.upon,the,heits, executors, administrators, assigns
and successors in interestof the Applicant and Owner. Iri;the event the Frederick County Board of
Supervisors grant said rezoning and accepts, these ponditio,as,, the proffered conditions shall apply to
the land rezoned in addition .to.rother-regtiureiAet is set'fofth in the Frederick County Code.
PLAT SHOWING
0 200 400 SUBDIVISION
OF THE PROPERTY OF
TH 0 WINCHESTER MEDICAL CENTER, INC.
INST. # 000012098
1 ,r =ZOO GAINESBORO MAGISTERIAL DISTRICT
O // FREDERICK COUNTY, VIRGINIA
(J SCALE: 1" = 200' DATE: JULY 27, 2004
A. ST01M gilbert w. clifford & associates
No. 002342 A DIVISION OF
O PATTON HARRIS RUST & ASSOCIATES
A PROFESSIONAL CORPORATION
0¢ CONSULTING 7 E. PICCADILLY STREET, WNCHESTER,nPLANNING
VIRGINIA 22601
(540) 667-2139 SHEET 7 OF
VIR
This in t'r ent �EDBRICK CO
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and
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was admitted to record. T O!'Iedgement th,,
In'Posed by Sec. 5 to annexed
8.14802,
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have been paid, if assessable
Clerk
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Mstrument of writing 'Y' COUNn,
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certificate and wit certifi t /0
an
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was admitted t re 0�,Iedgement the•
T znz-ol%-,�
rd, IrnPOsed by sec, 58-14802 of
and 58j-801 have be paid, if assessabi,.
'Clerk
4.
Inn1:0r�od�
OCT 4 2004
APPLICATION AND CHECKLIST
SUBDIVISION FREDERICN
FREDERICK COUNTY VIRGINIA I NNING & D
Date: D Application # 16 —OK
Fee Paid
Application / Agent: Patton Harris Rust & Associates, Pc
Address: c/o Ronald A. Mislowsky
117 E. Piccadilly Street, Suite 200
Winchester, VA 22601
Phone: (540) 667-2139
Owners name: Winchester Medical Center
Address: 1840 Amherst Street
Winchester, VA 22601
Phone: 540-
Please list names of all owners, principals and / or majority stockholders:
Doug Rosen, Vice President
Contact Person: Ronald A. Mislowsky
Phone: (540) 667-2139
Name of Subdivision: Courtyard by Marriott and Winchester Medical Center
Number of Lots: 3 Total Acreage: 13.5
Property Location: North side of US Route 50, immediately west of VA Route 37
interchange
Magisterial District: Gainesboro
Property Identification Number (PIN): 53-A-68
Property zoning and present use: B2/vacant
Adjoining property zoning and use: RA/residential
Has a Master Development Plan been submitted for this project?
Yes X No
If yes, has the final MDP been approved by the Board of Supervisors?
Yes X No
What was the MOP title? Winchester Medical Center
Does the plat contain any changes from the approved MDP?
Yes No X
If yes, specify what changes:
Minimum Lot Size (smallest lot) 2.91 acres
Number and types of housing units in this development:
Number: N/A
Types:
4
��
10,
2 1r,, , 4
NT
Frederick County Planning I PLANNING & D
Attn: Planning Director
107 N. Kent St.
Winchester, VA 22601
(540) 665-6352
The City of Winchester Planning Department is located in Rouss City Hall at 15 North
Cameron Street in Winchester, if you prefer to hand deliver this form.
Applicant's name, address and phone number:
Patton Harris Rust & Associates, Pc
c/o Ronald A. Mislowsky
117 E. Piccadilly Street, Suite 200
Winchester, VA 22601
Name of development and/or description of the request:
Courtyard by Marriott and Winchester Medical Center
Location:
North side of Us Route 50, immediately west of VA Route 37 interchange
Planning Directors Comments:
Director Signature and Date:
(NOTICE TO DIRECTOR - PLEASE RETURN THIS FORM TO APPLICANT)
NOITCE TO APPLICANT
It is your responsibility to complete this form as accurately as possible in order to assist
the agency with their review. Please also attach a copy of your application form, location
map, proffer statement, impact analysis, and all other pertinent information.
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SUBDIVISION 116-04 COURTYARD BY MARRI
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