Fillable APPLICATION ADMINISTRATIVE TELECOMMUNICATIONS PERMIT (City of Winchester)

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APPLICATION ADMINISTRATIVE TELECOMMUNICATIONS PERMIT (City of Winchester)

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The APPLICATION ADMINISTRATIVE TELECOMMUNICATIONS PERMIT (City of Winchester) form is 2 pages long and contains:

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  • 18 check-boxes
  • 50 other fields

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File type: PDF

U.S.A. forms for City of Winchester

BROWSE CITY OF WINCHESTER (VA) FORMS

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CERTIFICATE #: ATP-_________
DATE SUBMITTED:_________
APPLICATION
ADMINISTRATIVE TELECOMMUNICATIONS PERMIT
Please print or type all information ___________________________________________________________
Applicant
__________________________________________________ ___________________________________________________________
Telephone Street Address
__________________________________________________ ___________________________________________________________
E-mail Address City State Zip
__________________________________________________ __________________________________________________________
OWNER’S SIGNATURE (use reverse to list additional owners) Owner Name (as appears in Land Records)
__________________________________________________ __________________________________________________________
Telephone Street Address
__________________________________________________ ___________________________________________________________
E-mail Address City State Zip
PROPERTY LOCATION
Current Street Address(es)_________________________________________________________________________ Use _____________
Zoning: ______________ Zoning Overlay: ______________ Related Site Plan? No____ Yes____ Number: ___________________
TYPE OF REQUEST – Submit required materials and any additional information with this form.
# Antennas Added: _____
# Antennas Removed: _____
Fee: $500.00
Other (specify): ________________________________________________
Will the height of the telecommunications facility be increased: Yes No
If yes, how much: ________
Will the width of the telecommunications facility be increased: Yes No
If yes, how much: ________
Will there be changes to the supporting ground equipment: Yes No
REQUIRED MATERIALS LIST
_____ 1 copy of application (this form completed)
_____ Fee (check made payable to the Treasurer, City of Winchester)
_____ 2 copies of plans (elevation drawings, site plan, etc.)
_____ Letter explaining request and compliance with Zoning Ordinance Section 18-2
Please note that requests that include a property within the Historic Winchester or Corridor Enhancement overlay zoning district, a certificate
of appropriateness is required. Requests involving changes to ground support equipment and/or site features, a site plan may be required.
Only a complete application, which includes all the above materials, will be accepted.
===================================================================================================================
I/We hereby certify that the above information is complete and correct and that public notification will be properly posted on the site not
later than 14 days before the public hearing (if applicable) and that all delinquent Real Estate taxes have been paid per Section 23-9.
SIGNATURE _________________________________________________________ DATE __________________________________
APPLICANT
Rouss City Hall
15 North Cameron Street
Winchester, VA 22601
(540) 667-1815
TDD (540) 722-0782
CITY OF WINCHESTER, VIRGINIA
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______________________________________________ ______________________________________________
Additional Owner's Name Address
_______________________________________________ _____________________________________________
City, State, Zip Telephone
______________________________________________
OWNER’S SIGNATURE
______________________________________________ ______________________________________________
Additional Owner's Name Address
_______________________________________________ _____________________________________________
City, State, Zip Telephone
______________________________________________
OWNER’S SIGNATURE
______________________________________________ ______________________________________________
Additional Owner's Name Address
_______________________________________________ _____________________________________________
City, State, Zip Telephone
______________________________________________
OWNER’S SIGNATURE
______________________________________________ ______________________________________________
Additional Owner's Name Address
_______________________________________________ _____________________________________________
City, State, Zip Telephone
______________________________________________
OWNER’S SIGNATURE
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APPLICATION ADMINISTRATIVE TELECOMMUNICATIONS PERMIT (City of Winchester)

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Completed 17 July 2020

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