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COMMONWEALTH OF VIRGINIA COUNTY OF CUMBERLAND Zoning Permit Application Tax Map Number: Zoned: Acreage: Plat/Scaled Drawing must be attached to ALL Zoning Permit Applications A Zoning Permit must be issued before starting construction or locating any structures. Application is hereby made for a ZONING PERMIT in accordance with the description, use and purposes hereinafter set forth. This application is made subject to all local and State laws and ordinances, which are hereby agreed to by the undersigned, and which shall be deemed a condition entering into the exercise of this permit. NOTE: This permit does not provide any assurance with respect to the actual location of property lines, and the permit applicant is responsible for establishing the true location of any such property lines prior to construction or locating any structures on the property. Please see next page for permitting requirements I hereby covenant to restore any and all damages to sidewalks, streets, alleys, sewers, gas mains and electric installation which may result from excavation or development. I further certify that I have the authority to make the foregoing application, that the statements made and information given is correct and the construction of any building or the location of any structure of the tract or lot which is the subject of this application will conform with the regulations in the Building Code, Zoning Ordinance, proffers or conditions on the property, and private building restrictions, if any, which may be imposed. Print Name of Applicant Signature of Applicant Date Internal Use only Is development in a DBIZ? Yes ☐ No ☐ Does the development require E & S? Yes ☐ No ☐ VSMP? Yes ☐ No ☐ Application is: Approved Rejected Conditional Use Permit Zoning Administrator Date . Department of Planning & Zoning - P.O. Box 110, Cumberland, VA 23040 - P: (804) 492-3520 F: (804) 492-3697 Receipt# Name and Address of Applicant: Name and Address of Property Owner: Describe all existing and proposed structures and use thereof: All existing structures: Proposed: Water-Sewerage Requirements: Well County Water Septic Tank County Sewer Setback Requirements: Front: from the centerline of roadway. Side: Rear: Accessory Building Setback: SIGN ---PAGE BREAK--- Page 2 of 2 Last revised: 1/6/2020 Permit Requirements Planning/Zoning Permit Approved ([PHONE REDACTED]) Complete this first Approved in Lieu of E & S and/or Plan, also you may need to meet Stormwater Regulations (Planning Dept.[PHONE REDACTED]) Health Permit Approved by Health Department, ([PHONE REDACTED]) (Bring copy of Approved Zoning Permit and Plat/Scaled Drawing) Or Executed Water/Sewer User Agreement (Administration 804-492- 3625) Highway Entrance Permit Approved by VDOT (Charles D. Edwards: [PHONE REDACTED]) Used Singlewides Require a Copy of Title Verify Business License with Commissioner of the Revenue’s Office ([PHONE REDACTED]) 2 sets of plans to be approved by Building Inspections (New Singlewide/Doublewide: Footer diagram, floor plan & HUD disclosure) This includes: decks/porches/gazebos etc. Copy of Contractor’s Licenses through DPOR (Class A, B or C) Building Permit Issued & fees collected once all the above is Completed (please bring copies with you to our office) Adopted by the Cumberland County Board of Supervisors June 10, 1998 Cumberland County Policy for Building on Shrink-Swell Clays If Shrink-Swell Clays are found to be present during the footing inspection, for any structure regulated by the Uniform Statewide Building Code, the Building Code Official shall determine if a designed footing and foundation is required for that structure. If a design footing and foundation is required, the design must be by an engineer or architect licensed by the state of Virginia, and be based on site-specific soil investigation, or presume the presence of high shrink-swell soil and design to overcome the limitations presented by these soils.