1. current land use:
q
Vacant
q
a
gricultural
q
r
esidential
q
c
ommercial
q
i
ndustrial
2. lot dimensions (ft.) lot area (sq. ft.)
3. P
roPosed use of the Building?
B
UILDING DIMENSIONS: FT. X FT. = TOTAL (SQ.FT.)
N
UMBER OF STORIES:
4. s
etBack information
Distance from the Front Property Line:
Distance from the Rear Property Line:
BUILDING HEIGHT (FT.):
Distance from the Right Property Line:
Distance from the Left Property Line:
IS THE PROPERTY ON A CORNER LOT?
q
YES
q
N
O IF YES, WHICH SIDE?
5. Parking: numBer of Parking sPaces:  (enclosed) (outdoors)
c
urB cut required for driVeway or Parking area?
q
yes
q
n
o
tyPe of Parking area PaVement:
q
a
sPhalt
q
c
oncrete
q
P
lant mix
q
g
raVel
q
B
rick
q
o
ther
6. grading required? qyes qno if yes, amount of land disturBed (sq. ft.):
7. PuBlic street road frontage (ft.):
8. Is any portion of lot in Flood Plain or Floodway? Yes No
PARCEL ID NUMBER:
current Zoning:
R-1
R-2 C-1 C-2 M
A
PPLICANT NAME:
ADDRESS:
P
HONE: EMAIL:
Town of Altavista
ZONING APPLICATION
PERMIT NO.
NATURE OF PROJECT (PLEASE PROVIDE A BRIEF DESCRIPTION OF THE PROJECT):
exPected Project comPletion date: estimated cost of the Project:
PERMIT IS FOR:
Town of Altavista 510 7th Street Altavista, VA 24517 Phone: (434)-369-5001 Fax: (434)-369-4369 www.altavistava.gov
ProPerty owners name & address:
(IF DIFFERENT FROM APPLICANT)
New Building Addition Alteration New Occupant Home Occupation
(please complete home occupation sheet)
Zoning Application Fee: $20
BY SIGNING BELOW, I CERTIFY THAT THE INFORMATION ON THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE.
OWNER SIGNATURE (if applicable)
date
For Community Development Office Use Only
Building Permit Required: YES NO
**Campbell County Building Permits and Inspections | 85 Carden Lane | Rustburg, VA 24588 | (434)-332-9596
s
ite Plan required?
q
yes
q
n
o e & s Permit required?
q
yes
q
n
o
Town of Altavista Business License Required?
q
yes
q
no
aPPlication:
q
aPProVed
q
denied
Zoning administrator signature date
Proposed project diagram or Site Plan must accompany this application.
CONTRACTOR INFORMATION STATE LICENSE NO.:
N
AME/COMPANY:
ADDRESS:
PHONE: EMAIL:
Town of Altavista 510 7th Street Altavista, VA 24517 Phone: (434)-369-5001 Fax: (434)-369-4369 www.altavistava.gov
APPLICANT SIGNATURE
date