2. Date of Request*
   Date of Request
4. Name of Project
6. Address of Request*
   Street Address, City, State, Zip Code
8. Description of Request*
12. Application Information
14. Property Owner
16. Owner Contact Name*
18. Address of Owner*
    Street Address, City, State, Zip Code
20. Telephone No.*
21. Fax No.
23. Email Address
25. Developer (if applicable)
    Street Address, City, State, Zip Code
26. Engineer (if applicable)
    Street Address, City, State, Zip Code
28. Contact Name & Address*
    Street Address, City, State, Zip Code
30. Telephone No.*
31. Fax No.
33. Email Address
35. 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 application.
39. Site Plan Information
41. Site Acreage
43. Parcel Identification*
    Subdivision Lot & Parcel # and/or Tax Map Designation
45. Current Zoning
47. Existing/Proposed Square Footage of Structure(s) (if applicable)
49. Name of Subdivision
    (if applicable)
51. Proposed Land Use Activity*
52. Current Land Use Activity*
54. Vehicles per Peak Hour (VPH)
55. Traffic Impact Analysis
    (if required)
57. Contract Purchaser
    name, address and approval if applicable
61. Attachments
63. Attachments*

    Check all applicable below:

    1. Conceptual Plan
    2. Adjacent Property Owners Form
    3. Plat of the Subject Property
    4. Responses to Questions on following page
    5. Owner's Power of Attorney Affidavit, if not applicant
    6. Required $1,500 fee
    7. Traffic Impact Analysis Fee ($500-100VPH or less, $1,000-more than 100VPH)
65. Conceptual Plan*
67. Plat of Subject Property*
69. Traffic Impact Analysis
    (if required)
71. Please email attachments to siteplans@colonialheightsva.gov to include with your submission if error occurs attaching files above.
73. Planning Commission
    Planning Commission
75. Other
    Other
77. 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.
79. Parcel ID #*
80. Name
81. Street Address*
85. Questions
87. Purpose for Special Exception Permit:*
89. How does this request conform to the City's Comprehensive Plan:*
91. Explain how this request will have minimum adverse impact on the surrounding neighborhood or community:*
93. Please list any environmental or unique features of the property:*
95. Please list any known or suspected historic resources on the property and adjacent properties:*
97. Have you prepared a conceptual plan of the proposed development, including proposed uses, general lot configurations and road locations?*
    A conceptual plan needs to be filed with the application. The conceptual plan shall include, not limited to, a scaled drawing depicting the parcel showing property lines, the location of all existing structures with measured setbacks, location of proposed structures with measured setbacks, any environmental issues (i.e.: limits of wetlands, RPA 100’ buffer, RMA, Flood Plain), location of any historic resources, and location and dimensions of what is being considered for the special exception permit.
Leave This Blank:


99. 1. Receive an email copy of this form.
100. Email address

     This field is not part of the form submission.

101. Submit

* indicates a required field