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Page 1 of 2 Cumberland County Department of Planning ♦ Box 110 ♦ Cumberland, VA 23040 ♦ [PHONE REDACTED] ♦ Fax – [PHONE REDACTED] COMMONWEALTH OF VIRGINIA COUNTY OF CUMBERLAND Application for Poultry Development Plan Last revised 10/23/14 Form must be completed in ink, Pencil will not be accepted. Sections 74-991 through 998 of the Cumberland County Zoning Ordinance provide zoning standards for poultry facilities. In addition, a citizen’s guide has been developed to explain the process and standards. Please contact the Planning Department if you would like more info. General Information Expansion of existing facility or new facilities How many expanded or new buildings are What poultry company are you working with and what is the name and contact info for company representative you are working Location Address: Tax Map Comprehensive Plan Area: Do you have a nutrient management plan? If so attach. YES NO Will you be impacting wetlands or streams in the construction or operation of your poultry houses? If so, certification from DEQ and/or the Army Corps of Engineers is required. YES NO Owner of Record (who currently owns the Daytime Phone: Fax Applicant (if different from Daytime Phone: Fax Internal Use Only FILE COMPLETED___________ FEE/Ck. RECEIPT ---PAGE BREAK--- Page 2 of 2 Cumberland County Department of Planning ♦ Box 110 ♦ Cumberland, VA 23040 ♦ [PHONE REDACTED] ♦ Fax – [PHONE REDACTED] Describe the number, size (length x width) and location of the planned poultry facilities: Attachments Required: 1. E & S Plan if over 10,000 sq. Feet of land disturbance 2. Nutrient Management Plan. 3. Scaled development plan showing setbacks to property lines, roads and residences. 4. Proof of VSMP coverage. Owner/ Applicant Must Read and Sign I hereby certify that I own the subject property, or have the legal power to act on behalf of the owner in filing this application. I also certify that the information provided on this application and accompanying information is accurate, true, and correct to the best of my knowledge. Print Name of Owner/ Applicant Date Signature of Owner/ Applicant Daytime Phone # of Signatory