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Special Exception Permit Application
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This form has been modified since it was saved. Please review all fields before submitting.
Date of Request
*
Date of Request
Name of Project
Address of Request
*
Street Address, City, State, Zip Code
Description of Request
*
Application Information
Property Owner
Owner Contact Name
*
Address of Owner
*
Street Address, City, State, Zip Code
Telephone No.
*
Fax No.
Email Address
Developer (if applicable)
Street Address, City, State, Zip Code
Engineer (if applicable)
Street Address, City, State, Zip Code
Contact Name & Address
*
Street Address, City, State, Zip Code
Telephone No.
*
Fax No.
Email Address
Statement
*
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.
Site Plan Information
Site Acreage
Parcel Identification
*
Subdivision Lot & Parcel # and/or Tax Map Designation
Current Zoning
Existing/Proposed Square Footage of Structure(s) (if applicable)
Name of Subdivision
(if applicable)
Proposed Land Use Activity
*
Current Land Use Activity
*
Vehicles per Peak Hour (VPH)
Traffic Impact Analysis
(if required)
Contract Purchaser
name, address and approval if applicable
Attachments
Attachments
*
Check all applicable below:
Conceptual Plan
Adjacent Property Owners Form
Plat of the Subject Property
Responses to Questions on following page
Owner's Power of Attorney Affidavit, if not applicant
Required $1,500 fee
Traffic Impact Analysis Fee ($500-100VPH or less, $1,000-more than 100VPH)
Conceptual Plan
*
Plat of Subject Property
*
Traffic Impact Analysis
(if required)
Please email attachments to siteplans@colonialheightsva.gov to include with your submission if error occurs attaching files above.
Planning Commission
Planning Commission
Other
Other
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.
Parcel ID #
*
Name
Street Address
*
Questions
Purpose for Special Exception Permit:
*
How does this request conform to the City's Comprehensive Plan:
*
Explain how this request will have minimum adverse impact on the surrounding neighborhood or community:
*
Please list any environmental or unique features of the property:
*
Please list any known or suspected historic resources on the property and adjacent properties:
*
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.
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