2. Date of Request*
   Date of Request
4. Address of Request*
   Street Address, City, State, Zip Code
8. Applicant Information
10. Property Owner
12. Contact Name*
14. Address of Owner
    Street Address, City, State, Zip Code
16. Telephone No.
17. Fax No.
19. Email Address
21. Developer (if applicable)
    Street Address, City, State, Zip Code
22. Engineer (if applicable)
    Street Address, City, State, Zip Code
24. Contact Name*
    Street Address, City, State, Zip Code
26. Telephone No.*
27. Fax No.
29. Email Address
31. Statement*

    1. All information is accurate to the best of my ability. By checking this box, you are agreeing to sign and take responsibility for the work on this permit.
35. Site Plan Information
37. Site Acreage
39. Parcel Identification*
    Subdivision Lot & Parcel # and/or Tax Map Designation
41. Current Zoning*
43. Existing Square Footage of Structure(s)*
45. Proposed Square Footage of Structure(s)
47. Name of Subdivision
    (if applicable)
49. Proposed Land Use Activity*
51. Vehicles per Peak Hour (VPH)
52. Traffic Impact Analysis
    (if required)
56. Attachments
58. Attachments*

    Check all applicable below:

    1. Adjacent Property Owners Form
    2. Thirteen Copies of the Plat of the Subject Property and Preliminary Plans
    3. Responses to Questions on following page
    4. Conditional Zoning document (if applicable)
    5. Applicants Affidavit, if not owner
    6. Required $1,500 fee for Zoning Request
    7. Building Elevations
    8. Traffic Impact Analysis Fee ($500-100VPH or less, $1,000-more than 100VPH)
60. Attachments

    If additional attachments need to be sent, please send them to siteplans@colonilaheightsva.gov 

62. Planning Commission
    Planning Commission
64. Other
    Other
66. Adjoining Property Owners
    All adjacent property owners shall be listed. Adjacent property owners include all property across from roadways, watercourses, railroads, and/or municipal boundaries. The names and addresses below are those of adjacent property owners as listed in the tax records of the City Assessor and County Assessor if applicable.
68. Parcel ID #*
69. Name
70. Street Address*
74. Rezoning Questions
76. Explain how this request is consistent with the Comprehensive Plan*
78. What is the Land Use and Transportation Plan Map designation of the subject property?*
80. Describe in Detail the Proposed Use of the Property.*
82. Explain how this request will impact the surrounding neighborhood and/or the City of Colonial Heights.*
84. List any sensitive environmental or unique features of the property.*
86. Have you prepared a conceptual plan of the proposed development, including proposed uses, general lot configurations and road locations?*
88. What provisions will be made to provide safe and adequate access to the subject property?*
90. Please identify any known or suspected historic resources on both the subject property and adjacent properties.*
94. Conditional Zoning Application
96. Approval
    The City Clerk on behalf of the City Council will send a letter to the applicant, with the approved ordinance including all proffers approved with the rezoning. Upon consideration of the proposed rezoning, the City Council shall consider the following factors and shall concur therein before acceptance of any of the additional conditions proffered.
98. Proffered Conditions
    (list all items)
100. Please explain the manner in which the proposed zoning itself gives rise to the need for the additional conditions, relationship to the rezoning and the physical operation of the property and consistency with the Comprehensive Plan.
102. Statement
     With the signing of this form, the property owner certifies that no cash contribution to the City has been solicited or offered as part of the proffer; as has no mandatory dedication of real or personal property, on- or off-site, for open space, parks, schools, fire departments or other public facilities.
104. Surety Bond required?
Leave This Blank:


106. 1. Receive an email copy of this form.
107. Email address

     This field is not part of the form submission.

108. Submit

* indicates a required field