2. Special Use Permit Application
   The deadline for Special Use Permit applications is the first Tuesday of the month. An application is complete when the fee and all request information is received.
4. Date of Request*
   Date of Request
6. Address of Request*
   Street Address, City, State, Zip Code
8. Name of Project*
10. Description of Request*
14. Applicant Information
16. Name of Applicant*
18. Applicant is...*
    -- Select One --Property OwnerContract PurchaserRepresentative of Owner or Contract Purchaser
20. Mailing Address of Applicant*
    Street Address, City State, Zip Code
22. Telephone Number of Applicant*
24. Email Address of Applicant*
26. Purchase Contract
    If applicant is the Contract Purchaser, attach contract.
28. 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.
32. Property Owner Information
    If applicant is property owner, skip section.
34. Name of Property Owner
36. Property Owner Mailing Address*
    Street Address, City, State, Zip Code
38. Telephone Number of Property Owner*
40. Email Address of Property Owner
44. Other Representative
    Provide information for engineer, developer, attorney, or permit expeditor associated with this application. If no other representatives are associated with this application, or information has already been provided in the applicant section, skip section.
46. Other Representative Contact Information
    Provide the name, company, mailing address, telephone number, and email address for all representatives associated with this application.
50. Parcel Identification*
    Subdivision Lot & Parcel # and/or Tax Map Designation
52. Site Acreage
54. Current Zoning
56. Existing/Proposed Square Footage of Structure(s) (if applicable)
58. Name of Subdivision
    (if applicable)
60. Proposed Land Use Activity*
62. Vehicles per Peak Hour (VPH)
63. Traffic Impact Analysis
    (if required)
67. Adjoining Property Owners
    All adjacent property owner information shall be listed below or separately attached. Please provide property address, property owner name, and property owner mailing address for each adjacent parcel to the subject property. Applicants may submit property cards to satisfy this requirement. Property cards may be printed at the City Assessor's Office. Adjacent property owners include all property across from roadways, watercourses, railroads, and/or municipal boundaries.
69. List information below*
    The names and addresses above are those of adjacent property owners as listed in the tax records of the City Assessor (or County Assessor, if applicable.)
71. Adjacent Property Owner Information
    Information may be attached here or filled out above.
75. Narrative
    The Comprehensive Plan is available on the City's website within the Planning Department webpage.
77. What is the Land Use and Transportation Plan Map designation of the subject property?*
79. Describe in Detail the Proposed Use of the Property.*
81. Explain how this request is consistent with the Comprehensive Plan.*
83. List any sensitive environmental or unique features of the property.*
85. Explain how this request will impact the surrounding neighborhood and/or the City of Colonial Heights.*
87. Have you prepared a conceptual plan of the proposed development, including proposed uses, general lot configurations and road locations?*
89. What provisions will be made to provide safe and adequate access to the subject property?*
91. Please identify any known or suspected historic resources on both the subject property and adjacent properties.*
95. Attachments*

    Check all applicable below:

    1. Adjacent Property Owners Form
    2. Thirteen Copies of the Plat of the Subject Property
    3. Responses to Questions on following page
    4. Owner's Power of Attorney Affidavit, if not applicant
    5. Required $1,500 fee
    6. Traffic Impact Analysis Fee ($500-100VPH or less, $1,000-more than 100VPH)
97. Attachments
99. If needed, please email additional attachments to siteplans@colonialheightsva.gov to include with your submission.
Leave This Blank:


101. 1. Receive an email copy of this form.
102. Email address

     This field is not part of the form submission.

103. Submit

* indicates a required field