Full Text
Cumberland County Department of Planning ♦Box 110 ♦ Cumberland, VA 23040 ♦ [PHONE REDACTED] ♦ Fax – [PHONE REDACTED] COMMONWEALTH OF VIRGINIA COUNTY OF CUMBERLAND Subdivision Application Form shall be completed in ink pencil will not be accepted. Last revised: September, 2021 1. Type of subdivision: (check appropriate boxes) Type Description Info Required Minor Includes: By-right division (division producing up to 5 lots) family division (1 lot per immediate family member) Deed/survey showing tract Final plat (see sec. 54-59 & 54-58 if applicable) Copy of Will with List of Heirs Final plat (see sec. 54-58) Major Division of any parcel producing 6 or more lots Preliminary Plat (see sec. 54-191) Rezoning Application (see sec. 54-192) Final Plat (see sec. 54-193) 2. Applicant Property Tax Map Name(s) Address: City: State: Zip: Contact number: Email Address: 3 Property Owner(s) (who presently owns the property?) Name(s): Address: City: State: Zip: Contact number(s): Email Address: Note: If the property owner(s) as shown by the tax commissioner’s office is (are) not the applicant, the owner’s (owners’) signed and notarized authorization(s) must be on the plat. Internal Use Only FILE COMPLETED____________ FEE/Ck. RECEIPT STAFF: ---PAGE BREAK--- Page 2 of 2 Cumberland County Department of Planning ♦ Box 110 ♦ Cumberland, VA 23040 ♦ [PHONE REDACTED] ♦ Fax – [PHONE REDACTED] 4. Surveyor/ Engineer/Architect (who completed the survey?) Firm Name: Name of Individual Preparing Plat: certification Daytime Phone: Fax 5. Certification* *If signatory is not owner of record, a completed “Owner/Agent Agreement” must be attached. The undersigned herby certifies that all information submitted with this application is complete, true and correct. I understand any errors and/or omissions may lengthen the time to process the request. Print Name of Property Owner 1 Signature of Property Owner 1 Date Print Name of Property Owner 2 Signature of Property Owner 2 Date Print Name of Applicant Signature of Applicant Date SIGN SIGN SIGN