spotsylvania family exempt division packet

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FAMILY EXEMPT DIVISION PLAT APPLICATION PACKET Spotsylvania County Planning Department 10304 Spotsylvania Avenue, Suite 420 Fredericksburg, Virginia 22408 (540) 507-7434 FAX (540) 507-7445 www.spotsylvania.va.us UPDATED 5/1/08

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Here are the current rules (as of 2014) that Spotsylvania has enacted to divide a parcel of land for a family subdivision.

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Page 1: Spotsylvania family exempt division packet

FAMILY EXEMPT DIVISION PLAT APPLICATION

PACKET

Spotsylvania County Planning Department

10304 Spotsylvania Avenue, Suite 420 Fredericksburg, Virginia 22408

(540) 507-7434 FAX (540) 507-7445

www.spotsylvania.va.us

UPDATED 5/1/08

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Table of Contents TOPIC PAGE Definition Of Subdivide..................................................................................................... 3

General Information And Process .................................................................................... 5

Family Exempt Division Process Flow Chart.................................................................... 7

Soil Report Checklist ........................................................................................................ 8

Spotsylvania County Health Department Level I Subdivision Review .............................. 9

Family Exempt Division Plat Checklist ........................................................................... 10

Model Forms And Notes................................................................................................. 13

Other Required Plat Notes ............................................................................................. 14

Floodplain Note........................................................................................................... 14

Chesapeake Bay Preservation Act Notes................................................................... 14

Reservoir Protection Overlay District Note ................................................................. 14

River Protection Overlay District Note ........................................................................ 14

Highway Corridor Overlay District Note ...................................................................... 14

Additional Required Family Exempt Division Notes.................................................... 14

Owner’s Consent Of Transfer (Insert) ............................................................................ 15

Family Division Deed Restriction Language................................................................... 16

Family Division Affidavit And Form................................................................................. 16

Family Division Affidavit.............................................................................................. 17

Family Division Checklist................................................................................................ 18

Family Division Frequently Asked Questions.............................................................. 19

Appendix A - Plat Application ......................................................................................... 22

Spotsylvania County Plat Application ......................................................................... 23

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Definition Of Subdivide Following is the full definition of Subdivide as found in Chapter 20-2.1.3 of the Code of Spotsylvania County, and otherwise known as the “Subdivision Ordinance.” The definition includes the requirements for “Family Exempt Divisions beginning with Section B. Subdivide means the division of a lot, tract or parcel of land into two (2) or more lots, tracts, parcels or other divisions of land for transfer, sale or development. However, for purposes of these regulations the term “subdivide” shall not include divisions of land: A. Which consolidate existing lots or parcels by plat; B. Which divide a parcel of land in the Ru, A-1, A-2, A-3, resort agricultural (RA) and resort

residential (RR) districts for the purpose of sale or gift to a member of the immediate family of the property owner (as defined in Section 15.2-2244 of the Code of Virginia, provision for subdivision of a lot for conveyance to a family member: a member of the immediate family is defined as any person who is a natural or legally defined offspring, spouse, sibling, grandchild, grandparent, or parent of the owner), and is first held in ownership by the family member, pursuant to a recorded deed restriction for five (5) years from the date of transfer to the following standards:

(1) Minimum lot size shall be 2 acres including the remainder parcel;

(2) Lots shall have a scenic buffer strip thirty-five (35) feet in width along the existing

secondary or primary road frontage, in which the existing vegetation and contours of the land will not be disturbed or altered. Nothing in this section shall be construed to prohibit ingress/egress on the secondary or primary road where permitted by the standards of this chapter and VDOT, nor to prohibit the placement of fences or the planting of additional landscaping within the scenic buffer strip;

(3) All plats of division submitted under this provision shall be accompanied by a signed and

notarized affidavit indicating the date of transfer from parent(s) to the immediate family with instrument number or deed book and page number of the original transfer from parent(s) to immediate family;

(4) Any subsequent division(s) of the parcels created pursuant to this exemption shall

conform to the provisions of the Spotsylvania County Subdivision Ordinance for cluster or conventional divisions;

(5) The number of lots created under the family exempt provisions shall not exceed one (1)

lot per family member and the residential lot yield cannot exceed 10 lots from the parent parcel which existed on February 12, 2002.

C. All land divisions and/or consolidations as described in the preceding paragraphs above shall be

termed “exempt subdivisions” and shall be exempt from this chapter provided that all proposed lots or parcels:

(1) Generally conform to section 20-5.1.9 of this chapter;

(2) Meet all requirements of Chapter 23, Articles 6 and 7 of the Spotsylvania County Zoning

Ordinance;

(3) Comply with Chapters 6A, 8 and 19A of the Spotsylvania County Code;

(4) Front on an existing public road or are provided with a minimum of twenty-five (25’) foot wide access easement to an existing public road; with the approval of the subdivision agent this requirement may be reduced to a minimum eighteen (18) foot easement. Easements existing prior to December 4, 1995, and no less than ten (10’) feet in width

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(5) Share entrances on the existing public road to the maximum extent possible.

(6) Any access created for new divisions (exempt) created under these provisions shall be

limited to two thousand five hundred (2,500) feet in length with no extensions off of this road to adjacent properties unless owner can demonstrate no other means of access to a state maintained road exists at which time a waiver can be requested of the subdivision agent. Roads greater than three hundred (300) feet in length are required to end in a cul-de-sac or “T” turnaround per the DSM Plate 5-6 if serving more than 3 lots.

Number of Lots

Served by Road

Easement Width

Width of Travel Way Depth of Base

Surface Treatment of

Road

Sight Distance (Lot to Private

Lane)

2 lots 25 feet 12 feet (3 foot

shoulders)

4” of #25, 26, or 21A stone Not required 100 feet

3-10 lots 25 feet 12 feet (3 foot

shoulders)

6” of #25, 26, or 21A stone

Entrance paved 25’ from edge

of paved public road

100 feet

(7) All plats, contracts of sale and deeds for a lot in a subdivision in which private lanes, roads or streets are allowed shall contain language which clearly discloses to a potential purchaser the following minimum information;

(a) The lot is served by a privately maintained road and will not be maintained by the

state or county. Any costs necessary to bring the road to a condition qualifying it for acceptance as part of the secondary system of state highways shall be sustained from resources other than those administered by the Virginia Department of Transportation and the County of Spotsylvania or any other public agency;

(b) School bus service shall not be provided by the County along private roads, lanes

or streets; unless approved by the Spotsylvania County School Board;

(c) United States Postal Service shall not be provided along private roads, lanes or streets; unless approved by the United States Postal Service;

(d) The expense and responsibility for maintaining the roads within the development

shall be paid for and borne by the lot owners and/or developer, as the case may be; and

(e) It shall be the responsibility of the developer for the initial construction and

subsequent maintenance, if any, of the roads. If the roads are to be maintained by a property owners association or other legal entity, the disclosure must clearly so inform the buyer.

(8) Prior to recordation all such exempt subdivisions shall be submitted to the county

planning office for review and approval on a plat prepared by a licensed surveyor with application information as may be required by the subdivision agent.

Where the public (Spotsylvania County or a superior sovereign) acquires right-of-way in fee title crossing a lot, and upon application of the owner, the resulting lands on either side of such right-of-way may be

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approved administratively as separate lots upon the subdivision agent’s determination that either (i) at the time of the right-of-way acquisition; or (ii) at the time of the application, each portion of said land so divided satisfied all ordinance requirements for approval as separate lots within the meaning hereof.

General Information and Process

1. Zoning Determination: Contact the Zoning Department (540-507-7222) for the correct zoning

district designation. 2. Chesapeake Bay Preservation Ordinance, RPA, floodplain status, and any overlay

districts: Contact Code Compliance (540-507-7222) for overlay districts. 3. Subdivision Determination: Contact the Planning Department (540-507-7434) for questions

regarding the Subdivision Ordinance and what processes need to be followed. 4. Location of Septic Drainfields: Once it has been determined a Family Exempt Division can be

done, the applicant will need to hire a private Authorized Onsite Soil Evaluator (AOSE) consultant to locate a suitable drainfield location. Every parcel resulting from a land division (including the parent parcel) must have both a primary drainfield and a 100% reserve drainfield area delineated, unless public sewer is available. If an existing house with a septic system is located on a parcel proposed for division, a 100% reserve area should be located for that parcel as well. The “Soil Report Checklist” and the “Spotsylvania County Health Department Level I Subdivision Review” checklist (pages 8 & 9 of this packet) should be given to the AOSE consultant. The final plat will delineate all existing and proposed drainfield locations and be labeled accordingly.

For property line adjustments: For any parcel having its boundary line adjusted, the plat

must show that the parcel retains the primary and reserve drainfield capacity it had prior to the adjustment, including a minimum 100% reserve. A private AOSE soil consultant can make this determination.

With the completed application, a copy of any septic permits and/or certification letters that have already been issued by the Virginia Department of Health (VDH) and/or all Soil Reports prepared by an AOSE consultant must be included. Please note that providing a soil consultant’s report does not guarantee the issuance of a health permit. The VDH will not review the soil consultant’s work unless you file an application for a septic system construction permit. If you need complete assurance that the new parcel will have a suitable drainfield site, you should apply separately for VDH review. Contact the VDH (540-507-7386) for more information. Failure to identify the required primary and 100% reserve drainfields on a parcel will result in said parcel being stamped “Not Approved for Sewage” and a note placed on the plat stating “Lots stamped as not approved for sewage’ are considered un-buildable until a re-plat is subsequently filed and approved administratively by Spotsylvania County, according to current subdivision regulations” per Spotsylvania Code 20-5.1.9. To have the stamp and statement removed, the parcel will have to be re-platted and a Soil Report submitted, according to the County ordinances and standards in effect at that time.

5. Plat Preparation: After the drainfield locations are determined, a licensed surveyor or engineer

must prepare a plat (18” X 24”) of the proposed action. Give the “Family Exempt Plat Checklist” (pages 10 & 11 of this packet) to your surveyor. Your surveyor and soil consultant may need to work together to ensure that proposed property lines are correctly identified and related to drainfield areas, easements, structures, wells, and other environmental features found on the parcel.

An “Owner’s Consent and Dedication” (page 12 of this packet) is required to be placed on the plat. This must be completed and signed by all owners of the property.

Keep in mind, a plat is a legal document. It legally establishes the boundaries of the

parcels involved once recorded.

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To avoid future problems, please take care that all persons holding title to the land have signed. If you are unsure as to who should sign, check the most recently recorded deeds and wills or consult a private attorney.

Be aware that a plat does not transfer title. To convey title to any of the parcels you create, you will need to have an attorney prepare a deed. One (1) original, signed, and notarized deed needs to be submitted for review as part of the application for a Family Exempt Division.

6. Plat Review and Approval: Submit the following items to the Community Development Permit

Intake counter on the 4th floor of 10304 Spotsylvania Avenue, in the Lee Hill Commercial Center at Massaponax:

a. Completed “Spotsylvania County Plat Application” form (page 22 of this packet); b. Seven (7) folded copies of the plat (18” X 24”) sealed, signed, and dated by the surveyor

or engineer (Note: the initial review of a plat does not require the owner’s signature, etc.); c. One (1) original, signed, and notarized copy of the deed transferring ownership; d. One (1) completed, signed, and notarized “Family Affidavit” (page 16 of this packet); e. One (1) copy of all Soil Reports, septic permits, or certification letters, as applicable. f. Completed “Family Division” checklist (page 17 of this packet) g. All fees (see the top of the application form to compute)

The plat application submission will be reviewed for compliance with all existing and current County ordinances. The initial review of your application may take 4-6 weeks to complete. If changes are required to the plat, or any submitted documents, a second review will be required, again possibly taking an additional 4-6 weeks to complete. Included with each re-submittal, the Applicant must state, in writing, how each comment was handled, including why any comment may not have been addressed. If you need to schedule a closing date for a property transfer, please plan accordingly. Once the plat meets all requirements, the Subdivision Agent will sign the plat(s) to authorize recordation. Upon her/his approval, the applicant/owner who signed the application will be notified by the Planning Department to pick up the final plat(s), deed(s), and Family Affidavit(s) to be recorded.

7. Recording the Plat, Deed & Affidavit: The final, signed plat(s), deed(s), and Affidavit(s) must be

recorded in the Circuit Court Clerk’s Office (in the Judicial Center located at Spotsylvania Court House) by the Applicant. The Clerk of the Court will require a cover sheet. For more information on this procedure, contact the Clerk’s Office (540-507-7600). You will need two (2) copies of the County approved plat (both with original signatures), the original signed and notarized deed, the original signed and notarized Affidavit, a cover sheet, and the recording fees.

Plats will be considered void if not recorded within six (6) months

of County approval. 8. Special Note: Development of a new driveway/access (after plat approval) may require the filing

of a minor site plan with the Planning Department. Please contact Planning (540-507-7434) for further instructions.

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Family Exempt Division Process Flow Chart

Step 1: Contact the Zoning Office. Staff will determine your tax map parcel number, zoning, and whether the parcel is subject to special restrictions under the Chesapeake Bay Preservation Ordinance (540-507-7222).

Step 3: Hire a private soil consultant (AOSE certified) and/or contact the Health Department to locate any required drainfield areas with 100% reserve where applicable.

Step 4: Hire a Virginia licensed surveyor to prepare a plat of the existing and proposed property lines showing all drainfield locations, wells and existing structures.

Step 5: Submit all application materials and pay all fees to Permit Intake located in the Community Development offices on the 4th floor of 10304 Spotsylvania Avenue.

Step 6: If revisions are necessary, a letter, phone call or email requesting the changes will be sent to the owner or applicant and plat preparer. Applicant re-submits documents with corrections.

Step 7: Once the revisions are approved, Planning Staff notifies the Subdivision Agent that the plats are ready for signature and approval.

Step 8: The Planning Department contacts the owner or Applicant after the Subdivision Agent has signed the plats.

Final Step: The Applicant records the plat, deed, and Affidavit in the Circuit Court Clerk’s Office, with a cover sheet required by the Clerk’s office. Contact the Clerk’s Office (540-507-7600) for directions on preparing the cover sheet.

Step 2: Contact the Planning Department. Staff will determine how the Subdivision Ordinance relates to your application and guide you through the process (540-507-7434)

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Soil Report Checklist (Give this checklist to your soil consultant)

Note: The following information is needed to verify that the requirements of the Chesapeake Bay

Preservation Ordinance and the Reservoir Protection Overlay District that relate to parcel divisions and property line adjustments have been met. Soil reports in this format may be used to apply with the Health Department for a septic system construction permit or certification letter.

___1. Name, title, and signature of the person preparing the report (AOSE seal). ___2. Address, phone number, and fax number (if applicable) of a contact person. ___3. Soil profiles for all proposed drainfields and reserve areas. ___4. Statement indicating capacity of drainfield (in number of bedrooms), and percentage

reserve available (at least 100%). ___5. Scaled sketch showing the following: ___a. Property lines and dimensions of existing and proposed parcels. ___b. North arrow. ___c. Tax map parcel number. ___d. Bodies of water, including ponds, lakes, streams, drainage ways, etc. ___e. Resource Protection Areas. ___f. 250’ septic setback line from mean high water line of existing or proposed reservoirs;

100’ septic setback line from flood easement. ___g. Primary drainfield and reserve areas, including existing ones within 200’ on adjacent

parcels ___h. Footprints of existing and proposed buildings, with distance between dwelling(s) and

drainfields indicated. ___i. Distance between drainfields/reserve areas and property lines (5’ minimum setback). ___j. Existing or proposed driveways. ___k. Existing or proposed utility easements – Underground and aboveground (10’ minimum

setback for drainfields/reserve areas, or written permission for encroachment obtained from utility holding the easement).

___l. Proposed wells. ___m. Existing wells and springs within 200’ of the proposed building and drainfield/reserve

area, including those on adjacent parcels. ___6. If a parcel is vacant, a primary drainfield and 100% reserve area should be located or the

parcel will be stamped “Not Approved for Sewage.” ___7. If a parcel has a dwelling with an existing septic system, a 100% reserve area is identified

and located. ___8. VDH Level 1 Subdivision Review (sample included) (NOTE: Please note that soil reports need to clearly and accurately indicate the tax map parcel number(s), and that the property(s) has both primary and reserve drain fields, as required. The plat(s) need to depict both the primary and reserve drain field locations individually.)

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Spotsylvania County Health Department Level I Subdivision Review Spotsylvania TM #: _______________________________________________________________ Subdivision name: _______________________________________________________________ Developer: _______________________________________________________________ Surveyor: _______________________________________________________________ AOSE: _______________________________________________________________ Reviewing EHS: _______________________________________________________________ Date: _________________________

Items to be reviewed & required: per Sewage Handling and Disposal and AOSE Regulations Yes No N/A

Subdivision plat to scale of 1” = 100’ or larger Original topography shown at 2 ft. intervals or less Lot boundaries, lot line dimensions, acreage Overall site boundary Neighboring property lines within 200 ft. of outermost property line Existing and proposed roads, cuts and fills Drainage easements and structures Utility easements Significant landscape features (see county plat requirements) Existing & proposed water supplies for each lot & within 200 ft. of outermost

property Individual AOSE/PE Soil Reports identified as to individual lot, section number

and subdivision Drainfield sites, reserve areas, and water supply locations clearly shown to scale

on plat AOSE certification statement, signature, seal and date PE certification, seal and date Local government letter of request received

Items to be reviewed & required per Spotsylvania County

CBPA, River and Reservoir overlay detail (see site plan requirements Chapters 6A-13, 23-7.4.1-5, 23-7.5.1-.4 of the Spotsylvania County Code) as relevant to approval of individual and overall development plans.

Conformance with Chapters 20 & 23 of the Spotsylvania County Code

100% drainfield reserve areas exist for all newly created lots.

The minimum buildable lot area >10,000 contiguous sq. ft is available outside of

protected areas including drainfields and reserves.

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Family Exempt Division Plat Checklist

I. Application Completeness Review: File #: Name: Date Received: Date sent to GIS: ___1. The seven (7) folded plats (18” X 24”) submitted are sealed, signed, and dated by the

surveyor (original signatures required on all copies). ___2. The Soil Consultant's reports, or Approved VA Department of Health permits, are

provided indicating availability and location of the primary drainfield area with a 100% reserve capacity (individually delineated) for each parcel. If a septic system already exists on the parcel being divided, a 100% reserve area for that system should be located. Soil reports shall meet VDH minimum information requirements. AOSE certification is required. One copy of the soil report is provided for each lot created and/or adjusted.

___3. The individuals listed on the “Family Division Affidavit” are eligible according to Chapter 20-2.1.3, and the affidavit is complete, signed, and notarized. All names match the plat exactly. The Affidavit contains the name and address of the person(s) filling out the document.

___4. One (1) original, signed, and notarized deed is submitted that matches the plat and Affidavit exactly and contains the required 5-year retention and private road clauses (see pg. 15 of this packet).

___5. The division is exempt from regulation under the Subdivision Ordinance (Sec. 20-2.1.3, definition of Subdivide), the parcel existed on February 12, 2002, and/or the allowable divisions of the parent parcel since February 12, 2002 have not been exhausted.

___6. The application form is complete, signed by the owner or agent with POA, and all fees have been paid.

II. Plat Review:

___1. The Owner's Consent form and family notes are correct (see model forms and notes). ___2. All seven (7) of the plats contain all original signatures with the Owner's Consent form

signed by all parties. ___3. The Notary form is correct and includes a list of all signing parties (exactly as shown in

the Owner’s Consent and deed). The Notary has signed and their name is clearly readable (if they affixed their seal it must be able to be photocopied), and their Registration Number and Commission expiration date are shown.

___4. The Surveyor's certificate or seal is original, correct, complete, and signed and dated on all plat sheets.

___5. County review form is correct and states that Note under the County Review Form in bold that states, “NOTICE: THIS PLAT SHALL BECOME NULL AND VOID AND BE IN NO FURTHER FORCE AND EFFECT IF THE PLAT IS NOT RECORDED IN ACCORDANCE WITH THE SUBDIVISION ORDINANCE OF SPOTSYLVANIA COUNTY WITHIN SIX (6) MONTHS OF THE DATE OF APPROVAL.” [20-4.6.1(a)(4)]

___6. Note required on all plats, in bold that states, “APPROVAL AND/OR RECORDING OF THIS PLAT DOES NOT CONSTITUTE ASSURANCE THAT PUBLIC SEWER OR PUBLIC WATER SERVICE WILL BE AVAILABLE TO SERVE THE LAND DESCRIBED ON THIS PLAT AT ANY PARTICULAR TIME. [20-4.6.1(a)(4)]

___7. Inset sketch/Vicinity Map provided at a scale of 1”:2,000’ and includes a North Arrow. ___8. North Arrow present for the plat rendering. ___9. Floodplain boundary shown on plat if zone “A” touches parcel, or there is a note stating

that parcel is not in zone “A” per FEMA maps (see model forms and notes). ___10. Existing RPA is shown on the plat. Note as either field delineated or “RPA Shown per

County Maps.” Required RPA clause is shown in the Notes section (see Other Required Plat Notes).

___11. CBPA clause is present in the Notes section (see Other Required Plat Notes). ___12. The 35’ wide scenic buffer strip and note are shown on the plat for existing primary or

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secondary road frontages [Sec. 20-2.1.3, definition of Subdivide]. ___13. Family divisions have a minimum lot size of two (2) acres, including the remainder/parent

parcel, unless as noted below for properties in the River and Reservoir Protection Overlay Districts.

___14. Is the property within the Reservoir Protection Overlay District? If so, a note is included that identifies the property as being within the Reservoir Protection Overlay District. The additional restrictions are as follows:

___a. five (5) acre minimum lot size if using a septic system and the property is adjacent to an existing/proposed reservoir [Sec. 23-7.5.4(1)a].

___b. two (2) acre minimum lot size if using public sewer and the property is adjacent to an existing/proposed reservoir [Sec. 23-7.5.4(1)b].

___c. 200' lot width along mean high water line of existing/proposed reservoir [Sec. 23-7.5.4(2)].

___d. 150' buffer shown from the existing or proposed “mean” or “normal pooling level” of the reservoir [Sec. 23-7.5.4(3)a].

___e. 75' river and perennial stream buffer is shown [Sec. 23-7.5.4(3)b]. ___f. 250' septic setback from mean high water line of the existing or proposed reservoir [Sec.

23-7.5.4(4)b]. ___g. 100' septic setback from flood easement (Ni Reservoir only) [Sec. 22-232]. ___h. 200' septic setback if under 1.25 acres (Ni Reservoir only) [Sec. 22-232]. ___15. Minimums conform to the “River Protection Overlay District” standards. If the property is

located within the district, a note is added that identifies the property as such. ___a. five (5) acre minimum lot size if using septic system [Sec. 23-7.4.4]. ___16. If the property is located in the Highway Corridor Overlay District (HCOD): add HCOD

note – “This property is located in the County’s Highway Corridor Overlay District.” ___17. Existing and proposed primary and reserve drainfields are delineated on the plat (indicate

VDH permit numbers for existing drainfields) ___18. No drainfields in the 100-year floodplain [Sec. 23-7.4.7(1)]. ___19. No structures or septic systems are located within the RPA, unless a buffer reduction is

approved in accordance with Section 6A. Water wells are permissible [Sec. 6A-10(c)]. ___20. All drainfield systems are set back a minimum of five (5) feet from all property lines and a

minimum of 10' from all utility easements (including overheads) per VDH regulations. ___21. All existing structures are shown with no apparent building setback encroachments. ___22. No apparent access road/driveway entrance hazards exist. ___23. Minimum road frontage provided as required by the zoning district for public road

frontage [Sec. 23-6], if required. ___24. Parcels share access points on the existing secondary road to the maximum extent

possible [Sec. 20-2.1.3, definition of Subdivide]. ___25. If not fronting a public road, a minimum 25' wide private access easement (labeled as

“Private” and “Hereby Reserved” on the plat) is shown that does not exceed 2,500’ in length [Sec. 20-2.1.3, definition of Subdivide]. Required road maintenance, use, etc. language appears in the “Notes” section of the plat, as well as in the deed.

___26. No peculiarly shaped parcels or elongations exist, and no lot has a length five times greater than its width (5:1 rule) [Sec. 20-5.1.9(e)].

___27. No pipe-stem lots exist, except in RR zoning or by Planning Commission approval [Sec. 20-5.1.9(i)].

___28. Parcels provide desirable building site, with at least 10,000 contiguous square feet of buildable area exclusive of steep slopes (>15%), floodplains, wetlands, drainfields, reservoir/river protection overlay district buffers, and RPA [Sec. 20-2.1.3, definition of Buildable Lot].

___29. Property lines do not extend into a water body [Sec. 20-5.1.9(g)]. ___30. If the lot is minimum acreage, the Owner's Consent and/or plat do not say "more or less". ___31. Property lines to be eliminated are labeled “hereby vacated” or “hereby extinguished.” ___32. Adjacent property owners are correctly identified with deed book/page numbers and/or

land records (LR) recording number. ___33. All signatures are original and in blue ink. ___34. Plat title contains the tax map number and “Family Division” as part of its identification.

Also, surveyor contact information present, i.e. phone number, address, etc.

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III. Plat/Deed Approvals (Staff Only):

___ GIS has reviewed and approved plat. ___ Legal documents have been approved as to form. ___ Subdivision Agent has approved and signed plat.

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Model Forms and Notes

Family Division With Public/Private Roads

Surveyor’s Seal or Certificate

Review Form

Owner’s Consent

Form County Review/ Approval Note Other Notes

Public Road Frontage Seal 1 Yes CBPA, RPA, Floodplain, Overlay & Family Notes

Private Access Easement Seal 2 Yes CBPA, RPA, Floodplain, Overlay & Family Notes

OWNER’S CONSENT FORMS 1 & 2

COUNTY REVIEW/APPROVAL NOTE

Owner’s Consent #1: DESIGNATED AS PARCELS/LOTS USING PUBLIC ROAD FRONTAGE

Owner’s Consent and Dedication The creation of the parcels of land shown on this plat, containing __acres, and designated as (tax map # of parent parcel), (subdivision name/lot number) situated in ______Magisterial District, in the County of Spotsylvania, Virginia, is with the free consent and in accordance with the desires of the undersigned owners thereof. The undersigned owners certify that parcel/lot (tax map # of parent parcel) was created prior to February 12, 2002, and that the divisions have resulted in no more than 10 lots. The said ___acres of land hereby subdivided having been conveyed to (names of owners) by ___________ by deed dated _____________ 20__, and recorded in the Clerk’s Office of the Circuit Court of Spotsylvania County, Virginia, in Deed Book ___ Page __ or Instrument # ____________. Given under my/our hand(s) this _____day of ___________ 20__. _______________________(Seal) _______________________(Seal) State of_________________ City/County of __________________, to wit: The foregoing instrument was acknowledged before me by_________ this ____day of ____________ 20___. My Commission expires the day of , 20 . My Registration # is: . ____________________Notary Public _________________ __Printed Name

Owner’s Consent #2: DESIGNATED AS PARCELS/LOTS

USING PRIVATE ACCESS EASEMENTS Owner’s Consent and Dedication The creation of the parcels of land shown on this plat, containing ___ acres, and designated as (tax map #. of parent parcel), (subdivision name/lot number) situated in ____________ Magisterial District, in the County of Spotsylvania, Virginia, is with the free consent and in accordance with the desires of the undersigned owners thereof, all streets, access easements or accesses for this parcel/lot are private and do not comply with the Virginia Department of Transportation (VDOT) requirements for acceptance into the Secondary System and will not be maintained by either the County or VDOT. The streets, access easements or accesses shall be maintained by the owners of the parcels/lots and/or the owners of dwellings located on such parcels/lots that use the street, access easements or accesses. Prior to any future request for their addition to the State Secondary System, these streets, access easements or accesses must be developed in full compliance with VDOT requirements in effect at that time. Any such development shall be at the expense of the owners of the parcels/lots and/or dwellings located on such parcel/lots who use the streets, access easement or accesses. The undersigned owners certify that parcel/lot (tax map # of parent parcel) was created prior to February 12, 2002, and that the divisions have resulted in no more than 10 lots. The said __acres of land hereby subdivided having been conveyed to (names of owners), by deed dated____,20__, and recorded in the Clerk’s Office of the Circuit Court of Spotsylvania County, Virginia in Deed Book __, Pg. __ or Instrument # ____________. Given under my/our hand(s) this day of , 20 . _______________________(Seal) _______________________(Seal) State of ________________ City/County of __________________, to wit: The foregoing instrument was acknowledged before me by ____________ this ___ day of ____________, 20___. My Commission expires the day of , 20 . My Registration # is: ______________________Notary Public ______________________Printed Name

Based on the representations contained in the Owner’s Consent, this plat does not constitute a “subdivision” as defined in Section 20-2.1.3 of the Spotsylvania County Code. Further division of this parcel or the parent parcel may constitute a “subdivision” and require compliance with the County Subdivision Ordinance. County Administrator or Date Agent of the County Board of Supervisors NOTICE: THIS PLAT SHALL BECOME NULL AND VOID AND BE IN NO FURTHER FORCEAND EFFECT IF THE PLAT IS NOT RECORDED IN ACCORDANCE WITH THE SUBDIVISION ORDINANCE OF SPOTSYLVANIA COUNTY WITHIN SIX (6) MONTHS OF THE DATE OF APPROVAL. APPROVAL AND/OR RECORDING OF THIS PLAT DOES NOT CONSTITUTE ASSURANCE THAT PUBLIC SEWER OR PUBLIC WATER SERVICE WILL BE AVAILABLE TO SERVE THE LAND DESCRIBED ON THIS PLAT AT ANY PARTICULAR TIME. 13

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Other Required Plat Notes Floodplain Note The following is the preferred wording to be shown on all plats as it relates to FEMA Floodplain designations (the engineer/surveyor is responsible for replacing “xxx” with the correct FEMA map #):

“No portion of the land hereon is located in the F.I.R.M. 100-year special flood area zone “A”, as indicated on FEMA map # xxx dated February 18, 1998. However, this land is located in zone “X” (areas outside of the 500-year floodplain).”

OR “Portions of the land hereon are located in the F.I.R.M. 100-year special flood area zone “A” as

indicated on FEMA map # xxx dated February 18, 1998 and is so designated hereon.” Chesapeake Bay Preservation Act Notes Per the Chesapeake Bay Preservation Act and the Chesapeake Bay Preservation Ordinance of Spotsylvania County the following statements must be applied to all site plans and plats.

“CBPA is an overlay district for the entire Spotsylvania County and the parcel described within this plan lies within the RMA features and (does/does not) contain RPA features within the Chesapeake Bay Preservation Area Overlay District.”

If the parcel/lot does have a RPA feature on it, please include the following note:

“Resource Protection Area (RPA) is a 100 foot wide buffer area that shall remain undisturbed and vegetated in accordance with Spotsylvania County Code Chapter 6A- Chesapeake Bay Preservation.”

Reservoir Protection Overlay District Note If the parcel/lot is located in a Reservoir Protection Overlay District, include the following note:

This parcel/tract is located in the Reservoir Protection Overlay District of the County. River Protection Overlay District Note If the parcel/lot is located in a River Protection Overlay District, include the following note:

This parcel/tract is located in the River Protection Overlay District of the County. Highway Corridor Overlay District Note If the parcel/lot is located in the Highway Corridor Overlay District, include the following note:

This parcel/tract is located in the Highway Corridor Overlay District of the County. Additional Required Family Exempt Division Notes The following shall be placed in the “Notes” section on all affected plats:

VDOT approval required prior to access to all public roads. Per Section 20-2.1.3, Lots shall have a scenic buffer strip 35 feet in width along the existing

secondary or primary road frontage, in which the existing vegetation and contours of the land will not be disturbed or altered. Nothing in this section shall be construed to prohibit ingress/egress on the secondary or primary road where permitted by the standards of this chapter and VDOT, nor to prohibit the placement of fences or the planting of additional landscaping within the scenic buffer strip.

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Owner’s Consent of Transfer (insert) The following note shall be completed and inserted into the “Owner’s Consent and Dedication” (between paragraphs one [1] and two [2] of the model used) on each plat submitted. The accompanying deed of transfer must match the family names exactly as listed below: BY DEED(S) EXECUTED AND RECORDED CONCURRENTLY HEREWITH AMONG THE LAND RECORDS OF SPOTSYLVANIA COUNTY, VIRGINIA AS SET FORTH BELOW, THE PARCELS OF LAND CREATED BY THIS PLAT ARE CONVEYED TO (**whomever) OF THE UNDERSIGNED OWNER(S) WHO SHALL RETAIN TITLE TO SUCH PARCELS IN THEIR OWNERSHIP FOR A PERIOD OF 5 (FIVE) YEARS FROM THE DATE OF TRANSFER, IN ACCORDANCE WITH SPOTSYLVANIA COUNTY SUBDIVISION ORDINANCE SECTION 20-2.1.3. SUCH TRANSFERS ARE PROPOSED AS FOLLOWS: (add as many lines as there are family members receiving divisions from the parent parcel) PARCEL # GRANTEE NAME RELATIONSHIP GRANTOR ____________ __________________ __________________ _______________ ____________ __________________ __________________ _______________ ************************************************************************************************************************

(**whomever - Insert the full name and relationship to the owner in this space)

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Family Division Deed Restriction Language A) The following language shall appear in all deeds whereby a family division lot is initially

conveyed: Family Division. The lot conveyed herein is created by a family division of land; the conveyance herein is to an immediate family member of the Grantor; the Grantee shall retain title to such lot for a period of not less than five (5) years from the date of this conveyance; only one (1) such family division lot shall be conveyed to the Grantee within the County, and this conveyance is not made with the purpose or intent to circumvent the County’s subdivision ordinance requirements, all such provisions made in compliance with and as provided for in Section 15.2-2244 of the Code of Virginia and Section 20-2.1.3 of the Code of Spotsylvania County. A voluntary transfer or conveyance of this lot by the Grantee, within five (5) years of the date of this conveyance, to anyone other than (i) the Grantee’s spouse or (ii) an immediate family member (as defined by Section 20-2.1.3 of the Code of Spotsylvania County) of the Grantor of this deed shall render the family subdivision whereby this lot was created void and of no legal effect; and any subsequent division of this property must then comply with all requirements of Spotsylvania County Subdivision Ordinance as in effect at the time of such subsequent transfer. [Explanatory Note (do not include the following in the deed): The intent of this deed restriction language is to prevent circumvention of the Subdivision Ordinance by abuse of the Family Subdivision provisions. This language is not intended and shall not be construed to work a restraint on alienation of property. Transfer of a lot created by family subdivision within less than five (5) years shall, by this language, render the family subdivision void, but shall not in itself affect the transferee’s title to the property transferred. In consequence of this, the transferee would continue to hold title to the subject property, but such property would no longer constitute a legal lot for which a building permit, occupancy permit, or other governmental approval could be granted or maintained.] B) All plats, contracts of sale, and deeds for a lot in a subdivision in which private lanes,

roads or streets are allowed shall contain language which clearly discloses to a potential purchaser the following minimum information. Lots with frontage on state maintained roads, streets, or lanes are not required to use this language when accessing those roadways directly via a driveway

a) The lot is served by a privately maintained road and will not be maintained by the state or

county. Any costs necessary to bring the road to a condition qualifying it for acceptance as part of the secondary system of state highways shall be sustained from resources other than those administered by the Virginia Department of Transportation and the County of Spotsylvania or any other public agency;

b) School bus service shall not be provided by the County along private roads, lanes or

streets; unless approved by the Spotsylvania County School Board; c) United States Postal Service shall not be provided along private roads, lanes or streets;

unless approved by the United States Postal Service; d) The expense and responsibility for maintaining the roads within the development shall be

paid for and borne by the lot owners and/or developer, as the case may be; e) It shall be the responsibility of the developer for the initial construction and subsequent

maintenance, if any, of the roads. If the roads are to be maintained by a property owners association or other legal entity, the disclosure must clearly so inform the buyer.

Family Division Affidavit and Form

The affidavit on the following page must be completed, signed, notarized, and submitted with the application. The affidavit is to be recorded with the final deed of transfer.

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Family Division Affidavit STATE OF: Prepared By: CITY/COUNTY OF: Address: to wit: I/we, after having been duly sworn, do hereby certify and affirm that: (Print Name of Affiant/s) 1. [ ] I [ ] We hold title to the parent parcel identified below, and desire to divide the parent parcel under the authority of the County’s Family Exempt provisions as found in Section 20-2.1.3, definition of Subdivide, Subsection B. 2. The parent parcel is identified as: Spotsylvania County Tax Map # , also known by the street address of: or otherwise described as set forth in the attached "Exhibit A" (legal description from deed), recorded in: DB# Pg.# , dated , or LR # . 3. The transfer of the divided portion of the parent parcel will be to: whose relationship to me/us is/are: , such relationship being within the definition of an immediate family member (who has reached the age of 18) of the owner of the parent parcel as defined in Section 20-2.1.3 of the Spotsylvania County Code; and 4. That the deed of such transfer to be recorded in the Clerk's Office of the Spotsylvania County Circuit Court upon County approval of the proposed plat of division of land shall include a restriction on transfer or alienation of the land by the immediate family member (the grantee under the deed) for a period of not less than five (5) years from the date of transfer to such immediate family member named herein; and 5. THAT THE PROPOSED FAMILY DIVISION IS NOT FOR PURPOSES OF CIRCUMVENTING THE REQUIREMENTS OF THE SPOTSYLVANIA COUNTY SUBDIVISION ORDINANCE; AND FURTHER, I/we hereby affix our seal(s): (Print name of Affiant) (Signature of Affiant) (Print name of Affiant) (Signature of Affiant) I, , a notary public for the Commonwealth of Virginia, do hereby certify that affiant(s), whose name(s) is/are subscribed to the foregoing affidavit, duly swore and made oath that the facts contained herein are true and correct to the best of his/her/their information, knowledge and belief, all before me in the said County of Spotsylvania, State of Virginia, this day of , 20 . NOTARY PUBLIC Printed Name My commission expires the day of , 20 . My Registration number is:

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Family Division Checklist Project: Applicant Planner Initial: Initial: ____ ____ First page of the document bears an entry showing the name of either the person

or entity who drafted the instrument.

Prepared by: ____________________________ Address: ____________________________ City, State, Zip: ____ ____ Owners name on documents must match name on plat and match the name as

shown on the recorded deed where the owner acquired title. ____ ____ The Tax Map No. is listed at the top of the document. ____ ____ The Tax Map No. must be the same on plat. _____ _____ The property is zoned Ru, A1, A2, A3, RA or RR _____ _____ The parent parcel existed on February 12, 2002 _____ _____ The property is passing to a member of the immediate family as defined in

Section 20-2.1.3 of the Code of the County of Spotsylvania _____ _____ Minimum lot size is two (2) acres _____ _____ Lots which front on existing secondary or primary roads have a scenic buffer

strip of thirty-five feet (35’) in width _____ _____ Items of Section 20-2.1.3(C)(7) (a) through (e) of “subdivide” are included on

the plat, in the deed and where there are private roads _____ _____ Family deed restrictions language is included in the deed. ____ ____ The Notary must list his/her commission expiration date. ____ ____ The Notary must list his/her registration number. ____ ____ If sealed, whether by hand held or stamp, the notary must be able to be

reproduced by photocopy. ____ ____ The Notary should print his/her name under his/her signature and/or the

signature should be legible. ____ ____ If someone other than the owner is signing on behalf of the owner he/she must

provide a copy of a document authorizing a power of attorney to sign for any party to the document.

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Family Division Frequently Asked Questions

What was the intent of the family division ordinance that had been originally adopted on 7/12/05?

Land in the Ru, A-1, A-2, A-3, resort agricultural (RA) and resort residential (RR) districts are allowed to have family divisions;

Divisions are based upon the parent parcel as it existed on February 12, 2002 and no more than ten (10) total lots can be created;

Lots can be conveyed to a family member: defined as natural or legally defined offspring, spouse, sibling, grandchild, grandparent, parent, step-child, step-parent or step-siblings of the owner;

Include a recorded deed restriction for five (5) years from the date of transfer; Minimum lot size (which includes the parent/remainder parcel) shall be two (2) acres; Lots shall have a scenic buffer strip thirty-five (35) feet in width along the existing secondary

or primary road frontage, in which the existing vegetation and contours of the land will not be disturbed or altered. Nothing in this section shall be construed to prohibit ingress/egress on the secondary or primary road where permitted by the standards of this chapter and VDOT, nor to prohibit the placement of fences or the planting of additional landscaping within the scenic buffer strip;

All plats of division submitted under this provision shall be accompanied by a signed and notarized Affidavit indicating the proposed transfer of the parcel from one family member to another immediate family member as defined in Chapter 20-2.1.3 (B). The approved Affidavit must then be recorded with the deed and plat.

What changes in the original 7/12/05 ordinance resulted from the new family division

ordinance adopted on 10/9/07? Family member was re-defined as: “…a member of the immediate family is defined as any

person who is a natural of legally defined offspring, spouse, sibling, grandchild, grandparent, or parent of the owner…” to comply with the state code.

The number of lots created under the family exempt provisions shall not exceed one (1) lot per family member and the residential lot yield cannot exceed ten (10) lots from the parent parcel which existed on February 12, 2002.

What is the minimum lot size for parcels created under this ordinance?

Two (2) acres (including the parent parcel), unless located in the River or Reservoir Protection Overlay Districts, which may require a larger parcel (see Checklist).

What zoning districts allow family divisions?

A1, A2, A3, Ru, RR, & RA only.

Do I need to build a public (VDOT) and/or paved private road? No, you are only required to provide a minimum of a private, 25’ wide ingress/egress easement to the nearest public road for the new lot(s). No public road frontage is required. There are road standards depending on the number of lots created, though. These standards are detailed in the definition of subdivide (page 4 of this packet). A minor site plan may be required to construct a new driveway/access. Contact the Planning Department (540-507-7434) for further instructions.

How long do I need to keep the new parcel in the family name?

Once the lot is conveyed to an immediate family member, the new lot must remain in the family for not less than five (5) years. The five (5) year time period is committed to in a required deed restriction and on the plat. The five (5)-year period begins with the recording of the deed of transfer.

What is a deed restriction?

The deed transferring ownership must specifically state that the family division (lot) must stay in the family member’s name for a minimum of five (5) years from the date the property is deeded to said family member (see page 15 of this packet).

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Can I prepare my own deed for a family division?

Yes, but it is not advised, and it is strongly recommended that you hire an attorney to ensure all legal standards are met.

What is the definition of family?

Family is defined as the natural or legally defined offspring, spouse, sibling, grandchild, grandparent, or parent of the owner.

Is the spouse (husband or wife) of an immediate family member also considered a “family

member” as defined in the ordinance? No, for the purpose of deeding a lot under the Family Exempt Division process, only the individual who meets the definition of “family member” may be part of the recorded plat and deed transferring the property from one immediate family member to another.

If my land was divided prior to February 12, 2002, can I still divide it?

Yes. The requirement is based on the acreage of the parent parcel as it existed on February 12, 2002. Consult the Planning Department for a determination.

What if my property has been divided since February 12, 2002, can I do additional divisions of

this parcel? Yes, provided that all allowable splits have not been exhausted. Consult the Planning Department for a final determination.

How many lots can an individual family member receive under the Family Exempt Ordinance?

You can transfer only one (1) lot to each immediate family member during their lifetime.

Can a spouse (husband or wife) give the other a parcel under the Family Division Ordinance? Yes, but only if the spouse deeding the parcel is the only one named on the parent parcel’s deed, and then the new parcel must be deeded in the other spouse’s name only.

How many lots can I create?

The districts, A1, A2, A3, Ru, RR, and RA, allow no more than ten (10( lots based on the parent parcel of 2/12/2002.

What can I do in Resort Agriculture (RA) zoning?

RA allows family divisions only.

What if my land is landlocked and I want to create a family division? You will need to obtain a minimum of a 25’ wide access easement from any neighbor to the nearest public road. This is a private issue and can only be resolved between you and your neighbor(s). The county does not have any involvement in private easements.

How do I start the process?

Follow the plat procedures outlined in the “Family Exempt Division Plat Application” packet (see page 7 of this packet).

Can I divide land in a conventional subdivision?

If the parcel/lot is in a conventional subdivision (contact the Planning Department if you are not sure), it meets all the acreage requirements previously outlined, and there are no acreage restrictions imposed by a Homeowner’s Association, covenants, or the deed of ownership, you may be able to undertake a Family Exempt Division of your property. To be sure, though, consult with the Planning Department and your Homeowner’s Association, as well as checking both your deed and any subdivision covenants before beginning the process.

Can I divide a lot that has been recently created through the Family Division process

Yes, depending on the number of family splits that may have been previously undertaken and approved. Consult the Planning Department for a final determination.

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Can I do a conventional and family division on the same parcel at the same time?

No. The two processes are dissimilar, have different standards and requirements, and therefore must work independent of one another. After consulting with the Planning Department to determine what division rights may be available to you, you should complete the family division first, recording the new lots, and only then attempting to undertake a Record Plat for the remaining lots.

May I deed property to my family?

Yes, you may transfer property ownership to family members as defined in the ordinance. If you divide the property by deed or plat that will require a new tax map identification number, you will need County approval. If the property is deeded to all family members without dividing the property, no County approval is needed. If the tax map identification number changes for any reason, then County approval is required.

What is the minimum age a family member has to be in order to own (take title to) property in

Virginia? 18.

Can I deed a parcel to my minor (under 18) son/daughter through a Trust?

No. By the definition of family contained in the Ordinance, a “Trust” is not an immediate family member and, therefore, cannot be the recipient of a family division tract.

Can property held in an Estate be subdivided under the Family Exempt process?

No. By the definition of family contained in the Ordinance, an “Estate” is not an immediate family member and, therefore, is not eligible under the Family Exempt Ordinance.

Can a Will be used to subdivide property under the Family Exempt process?

No. By the definition of family contained in the Ordinance, a “Will” in of itself is not an “immediate family member” and, therefore, cannot be used as a family member under the Family Exempt Ordinance.

Is a right-of-way dedication required?

No, not unless you want to. You only need an ingress/egress easement that is a minimum of 25’ wide for the new parcels.

What if I divide land under the Family Division Ordinance and then sell it outside of the family

prior to the 5-years? Transfer of a lot created by a family subdivision within less than 5 years shall, by the deed restriction language, render the family subdivision void, but shall not in of itself affect the transferee’s title to the property transferred. In consequence of this, the transferee would continue to hold title to the subject property, but such property would no longer constitute a legal lot for which a building permit, occupancy permit, or other governmental approval could be granted or maintained.

When do I need to provide soil reports?

Soil reports proving both primary and 100% reserve drainfield capacity are required for any lot created (including the remaining portion of the parent parcel) upon application. If you wish to create a lot without septic capabilities, the lot may be approved, but it will not be approved for sewage and will be stamped “Not Approved for Sewage” on the plat and a note added to the plat stating “Lots stamped as ‘not approved for sewage’ are considered un-buildable until a re-plat is subsequently filed and approved administratively by Spotsylvania County according to current subdivision regulations.” per Spotsylvania Code 20-5.1.9. If you wish to build on a parcel so labeled in the future, it must be re-platted meeting all County ordinances related to drainfields, etc. in effect at that time.

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Appendix A

Plat Application

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Updated as of 3/5/08

SPOTSYLVANIA COUNTY PLAT APPLICATION

Submit the completed application, folded plats, fees, and supplemental information to Code Compliance Permit Intake

10304 Spotsylvania Avenue, 4th Floor Fredericksburg, VA 22408

Planning Department FEES

March 1, 2008 Fee Schedule 10304 Spotsylvania Ave, Ste 420 Planning: 110-0000-316-16-03 (39) $ Spotsylvania, VA 22408 Code: $250 prelim. $125 record/final 260-0000-313-03-45 (017) $ (540) 507-7434 (voice) Processing Fee: 260-0000-318-99-14 (017) $ 50.00 (540) 507-7445 (fax) GIS: 110-0000-316-16-10 (334) $ www.spotsylvania.va.us TOTAL FEE PAID: $

Type: (Check One) All plats must be folded prior to submission (Soil reports are required, if applicable)

___ Preliminary Plat 20 folded plats (Planning fee: Minor (9 lots or less) $2600 + 85/lot; Major (10 or more lots) $3000 + $100/lot; Code fee: $250; GIS fee: $2500)

___ Record Plat/Final Plat 13 folded plats (Planning fee: Minor (3 lots or less) $1500+100/lot; Major (4 or more lots) $2000 + $100/lot; Code fee $125; GIS $3500+ 10/lot)

___ Family Exempt Division 7 folded plats (Planning fee: $1000 + $50 per lot; GIS $300) ___ Consolidation or Adjustment 7 folded copies (Planning fee: $1000; GIS fee $300) ___ Easement or Right of Way Plat 8 folded copies (Planning fee: $1500; GIS fee $300)

Deed & certificate of title are required for right of way dedication Subdivision Name or Owner’s Name: __________________________________________________________________________

Section # _______ # of lots _______ Nearest State Route # _______ Zoning District _______

Voting District _________ Magisterial District ___________ Public Water: Y N Public Sewer: Y N Public Streets: Y N

Tax Map/Parcel # ____________________________________ Acreage _____________________________________________ __________________________________________________ ____________________________________________________

Developer (Owner if no developer) Engineer/Surveyor __________________________________________________ ____________________________________________________

Address Address __________________________________________________ ____________________________________________________

City, State, Zip City, State, Zip __________________________________________________ ____________________________________________________

Phone/Fax Number Contact Person Phone/Fax Number Contact Person E-mail: ____________________________________________ E-mail: _____________________________________________

E-mail will only be used to send comments as a result of the review. Signature(s): All owners must sign the application or submit an agent authorization letter. Signature(s) of owner(s) or authorized agent: Date: __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________

FOR OFFICE USE ONLY _______________________________________________________ ________________________________________

Application received by Date Application Number Zoning Dept: Zoning district information is correct. Density and lot sizes conform to district minimums. _________________________________________________________ Signature Date