APPLICATION FOR ZONING PERMIT

COUNTY OF APPOMATTOX
Department of Community Development

P.O. Box 863 ~ Appomattox ~ VA 24522

Phone (434) 352-8183 ~ Fax (434) 352-4214
APPLICATION FOR ZONING PERMIT
NAME OF APPLICANT:
Date of Application:

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number or Email Address:
example@example.com
CURRENT LANDOWNER (if different):
Mailing Address:
Property:
Tax Map Number:
Address/Street Name:
ENTRANCE:

New (VDOT permit needed)Existing
CHECK ALL BOXES THAT APPLY TO THIS APPLICATION:

Residential
Residential

Single-Family Dwelling (includes Modular Units)AdditionTwo-Family Dwelling (Duplex)PoolManufactured Home
Residential

Single-Wide
Year:
Serial #:
Residential

Double-Wide
Year:
HUD #:
Please Choose and specify below

Commercial:Industrial :
Specify Commercial
Specify Industrial
Accessory Structure:

Accessory Structure
Sheds/ Carports:
Dimensions
Material:
How many sides are enclosed?
SETBACKS (Proposed setbacks as viewed from the street/road): Please provide setbacks on the attached sketch or attach a plat, survey or aerial photograph showing the placement of any proposed structure(s) and include the setbacks.
STRUCTURE HEIGHT (Proposed height as measured from average grade to peak of roof):
Upload Plan Here

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Application for zoning approval must be made by the Landowner or with his/her permission. If the Applicant is different than the Landowner, then one of the following must accompany the application (1) Letter of permission from the Landowner, or (2) Copy of a signed contract or agreement for the work to be done OR (3) Copy of the contract to purchase the property, if applicable.

A Zoning Permit is required for the construction or placement of any structure. A Building Permit may also be required. The information provided, concerning the land use and zoning setbacks, is true to the best of my knowledge. I realize, as owner/applicant, that I am responsible for identifying the property lines for determination of setback compliance. I also realize if the setback requirements of the Appomattox County Zoning Ordinance are notmet, then I will be in violation of the Appomattox County Code.
Date

MonthDayYear
Date
Signature of Owner/Applicant*

Clear
For Office Use Only

Approved as ProposedApproved with conditions (see below)Disapproved
Approved with Conditions
Zoning District:
Zoning Administrator:
Date:

MonthDayYear
Date
FT

From center line of roadFrom front property line
How many feet from front property line to proposed structure?
How many feet from rear property line to proposed structure?
How many feet from right property line to proposed structure?
*Right side when you are facing the front property line
How many feet from left property line to proposed structure?
*Left side when you are facing the front property line
Should be Empty:

COUNTY OF APPOMATTOX

APPLICATION FOR ZONING PERMIT

Property: