72-T2STION
For O"~lce Use Only:
Case No. ??' ~T[~' --~
Zoning ~--~ ( '~~'
TO PARK
(NEW AND RENEWAL)
(Following inform~on is to be typed or printed)
FOR A USE PERMIT
A MOBILE HOME
Name of Applicant: ~~ ~. '~ ~~~ ~r. ~~Z
(Must be o~n~r & occupant of the Mo~lle Home')'
Addres of Applicant~/ ~~ ~. ~'
s ., ~ ~ ,, Telephone ~/~
MailinE address where mobile home will be located
*Magisterial District Tax Map No~F~,~)(~'.)
S ubd. Name .~~/~ ~/~ Lot o r Parcel~- ~lk' / Sec.
A map of this property must be attached to this application.
This map must be to scale.
Name of owner of property on which mobile home will be parked
(If the applicant i2'not the ~'6wne~ of the property in question,"'
explain. )
5. If mobile home will remain unoccupied, explain , /~/~ ,, ,
6. Time requested for mobile home to remain at site (use permit
granted for a maximum of two years only.)
months / years
?. Size and type of mobile home to be parked on the above noted
property. Make Model Color Width
Length No. of Bedrooms No. of Bathrooms
8. Source of water supply
Method of sewage disposal
Information obtainable from the office of the County Assessor.
(Room 213)
9. Information, addresses, and signatures of all property owners,occupants
who are adjacent to the parcel on which the mobile home be located must
be provided in the spaces below.
We, the undersigned owners and occupants of the adjacent
property to the property on which a mobile home is proposed to
be located, hereby certify that we do or do not object to the
granting of a Use Permit to park a mobile home on the property
described in this petition.
Information available from the office of the County Assessor (Room 213).
Name (print)
Tax Map No.
Address:
I do object
( )
Signat ute :..~
~'f_/,~z~> ~i/Zx~ ,,, Owner
Block No. / ..... Lot or Parcel No.
Check
One
Onl~
I do not object
/
************************************* *****************************
Name (print)~/~ ~. ~' ~/~../c/. Owner (~/) OcCupant ( )
Tax Map No. :7~ ~/~ Block NO. // Lot or Parcel No. ~--/d~'
I do object
( )
Check One Only
I do not ~ect
Name (print) ~ ~. ~/f~~ Owner (~) Occup~t ( )
Tax Map No. ~~~ Block No. // Lot or Parcel No. /~/~
Check One On!~y
I do object
( )
Signature:
Additional spaces on back of page.
I do(no~)bJect
(2)
Check One Only
I do object I do nob object
(
Signature .~/~'A-. .
Name (print)
Tax Map No.
Block No.
Address:
Owner ( ) Occupant ( )
Lot or Parcel No.
Check One On,ly
I do object I do not object
( ) ( )
Signature:
Name (print)
Tax Map No.
Block No.
Owner ( ) Occupant (
Lot or Parcel No.
Address:
Check One Only
I do object ~ I do not object
( ) ( )
Signature:
Name (print) , Owner ( ) Occupant ( )
Tax Map No. Block No. Lot or Parcel No.
Address:
I do object
( )
Signature:
Check One Only
I do not object
(
(3)
The Chesterfield County Health Department must make an inspection of
the proposed mobile home location, both before and after the mobile
home is installed. It is the applicant's responsibility to contact
the Health Department and make an appointment for this inspection
(telephone - 748-1398). The inspection Form must be attached to this
application.
The Applicant and/or his agent must be present at the Board hearing.
I/We hereby certify that all of the above statements and the statements
contained in any exhibits transmitted herewith are true. Further, that
all owners and occupants of adjacent property have signed Section No. 9
of this application and have been notified of the date and time of the
hearing.
ApPlicaht 'S sl~gnature -
Subscribed and sworn to before me this/$r~
My Commission
day of~.
'Notary Public'
CHESTEF~IELD COUV, T¥ HEALTH DEPAF, TI~?.NT
CT~:~T~ p~IELD VIRGINIA
,3~qu~st for Lot Evaluation
For ~
f~ner
Exact Location
of Premises
Lot
Applicant
Address ~/696 .~, ~fgd~ ~
Address
'Block section Str~e~ S'ubdi'v'~'~ion
/~usires to have a lot opinion that is subject to re-,
evaluation prior to issuance of Building P~rmito
/7. Is applying for Building. Permit :''~;
Type of Construction
/ ~"bwelling /-/ Other /.,-7 House plan not final
/--7 Auto. ~asher /,.7 Garbage Disposal /_/_'7 Public 5?ater./~Ind. ~ell
~,,ctual or potential bedrooms ~-'~stimated water consumptio~gpd.
~%ecommendations~ Based on present standards it is our opinion that
~iot has;
/~'/ FAVOPJAB~ /7 QUESTIONLBLE /7 NOT SUITED
Soil for septic tank an--d drainfield install--~tion.
This is not a
~ -~ San~rian .....
Dat~
Posted. Grid