2. Date of Request*
   Date of Request
4. Address of Request*
   Street Address, City, State, Zip Code
6. Property Owner/Tenant
8. Contact Name*
10. Address of Owner*
    Street Address, City, State, Zip Code
12. Telephone No.*
13. Fax No.
15. Email Address*
17. 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.
21. Site Acreage
23. Parcel Identification*
    Subdivision Lot & Parcel # and/or Tax Map Designation
25. Current Zoning*
27. Existing/Proposed Square Footage of Structure(s)*
29. Name of Subdivision
    (if applicable)
31. Proposed Land Use Activity
33. Contract Purchaser
    (name, address and approval if applicable)
35. Consistency with Zoning
37. Existence of RPA/RMA*
    Please note whether lot of record delineates the Resource Protection Area (RPA) per the Chesapeake Bay Preservation Area requirements.
39. Actions Taken/Date

    1. Approved
    2. Denied
40. Reason
42. Zoning Administrator
    Zoning Administrator
44. Date
    Date
48. Type of Project

    1. New Construction
    2. Addition
    3. Deck (uncovered/covered)
    4. Porch (uncovered/covered)
    5. Garage/Carport
    6. Pool
    7. Shed
    8. Manufactured Building
    9. Ramp
50. Dimensions of Structure
52. Setback (front property line)
53. Setback (side property line)
54. Setback (rear property line)
56. Estimated Cost
60. Attachments

    1. Required $50 fee
    2. Site Plan for Construction
    3. Construction Document(s)
62. Site Plan for construction to include: details, dimensions, location of construction*
    *please notate whether RPA/RMA exists on site
64. Construction Document
    May be submitted as a hard copy to the Building Official
66. Please email attachments to siteplans@colonialheightsva.gov to include with your submission if error occurs attaching files above.
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field