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SITE PLAN APPLICATION
Project Title:
N0az5 B4 &
Location of Property 1i�6�i✓P.>' /AkS SUED /t� /s /aF/
(street address)
Property Owner: f� /D j J 1A Spy LL
Address : 60 �t=70LA / AME,<-/CA
750 A(- k1Ao&5R z5o'Z/ 1/E 57e� ZreOO
U/ /Cf+6i� , / L-, 6av 1 0�
Telephone: S¢D 66Z —9757 (Z -oex,)
Applicant /Agent
Address
W/AICHES i✓A 2Z6p j
Telephone: 5¢0 667 `ZI39
Designer: PI-IN -j
Address:
Telephone:
Contact: ki), "WAA/ TD/xnnI
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Is this a standard or 'minor' site plan?
Is this an original or revised site plan?
Total acreage of parcel to be developed:
Total acreage of parcel:
Property Information:
Property Identification Number:
Current Zoning:
Present Use:
Proposed Use:
Adjoining Property Use(s)
Adjoining Property Identification Number(s)
Magisterial District(s)
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Standard _ Minor
Original Revised
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SFOIVEWALL
I have read the material included in this package and understand what is required by the Frederick County
Planning Department. I also understand that all required material will be complete prior to the submission
of my site plan.
Signature:
Date: // 123 /)0
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Know All Men By Those Present: That I (We)
(Name) Hidden Valley SPE LLC c/o Hometown America (Phone) (540) 662 -9757
(Address) 150 N. Wacker Drive, Suite 2800, Chicago, IL 60606
the owner(s) of all those tracts or parcels of land ("Property ") conveyed to me (us), by deed recorded in
the Clerk's Office of the Circuit Court of the County of Frederick, Virginia, by
Instrument No. 2003 24386 on Page and is described as
Tax Map 55 -A -27
do hereby make, constitute and appoint:
(Name) Patton Harris Rust & Associates (Phone) (540) 667 -2139
(Address) 117 East Piccadilly Street, Suite 200, Winchester, VA 22601
To act as ury true and lawful attorney -in -fact for and in my (our) name, place, and stead with full power
and authority I (we) would have if acting personally to file planning applications for my (our) above
described Property, including:
Rezoning (including proffers)
_ Conditional Use Permit
_ Master Development Plan (Preliminary and Final)
_ Subdivision
X Site Plan
_ Variance or Appeal
Comprehensive Policy Plat Amendment
My attorney -in -fact shall have the authority to offer proffered conditions and to make amendments to
previously approved proffered conditions except as follows:
This authorization shall expire one year from the day it is signed, or la til it is otherwise rescinded or
modified. n
In witness thereof. Ikq) have It¢i� set A(our) hand�"seal this Lq day of dr'!2f 20tJQ ,
Signature(s)
State of Virginia, City /County of
To -NviC
I,�ebf)r0 et' m ,i- a Notary Public in and for the jurisdiction
aforesaid, certify that the person(s vho signed to the foregoing instrument Pei' really appeared before me
and has acknowledged the same before "'e, in the jurisdiction aforesaid the day of tim4-2011(- 1 .
fl�J/ My Commission Expires: jui9_9 314
Notary Pub is EDORA L. MERRYMAN
NOTARY PUBLIC
Revised 3/17/08 Commonweakh of Virginia
Reg.# 7055774
My Commission Expires May 31, 2014
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Request For Site Plan Comments
Department of Planning and Development
Mail to: Hand deliver to:
Department of Planning and Development 107 N. Kent Street
Attn: County Planner North Building, 2nd Floor
107 North Kent Street Winchester, VA
Winchester, VA 22601 (540) 665 -5651
(540) 665 -5651
Please fill out the information as accurately as possible in order to assist the agency with their
review. Please attach two (2) copies of the site plan with this sheet.
Applicant's Name: Patton Harris Rust & Associates
Address: 117 E. Piccadilly Street, Suite 200
Winchester, VA 22601
Phone Number. (540) 667 -2139
Name of development and /or description of the request: Regency Lakes Section F
PavilionNollevball Plan
Location of property: Regency Lakes Subdivision
Planning and Development's Comments:
Planning and Development use only
Date received Date revision received - Date approved
Incomplete Incomplete. .
'Date reviewed Date reviewed
Signature and Date
Signature and Date (revision)
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