Comprehensive Plan
Map Amendment
www.harrisonburgva.gov/comprehensive-plan
Page 1 of 1 Last Updated: December 2, 2019
______________________________________________________
Property Address
________________ __________________ acres or sq.ft.
Tax Map Parcel/ID Total Land Area (circle)
Existing Comprehensive Plan Designation: __________________________________________________
Proposed Comprehensive Plan Designation: _________________________________________________
Existing Zoning Classification: ____________________________________________________________
PROPERTY OWNER INFORMATION
______________________________________________________
Property Owner Name
______________________________________________________
Street Address
________________________ _________ _________________
City State Zip
______________________________________________________
Telephone
______________________________________________________
E-Mail
OWNER’S REPRESENTATIVE INFORMATION
___________________________________________________
Owner’s Representative
______________________________________________________
Street Address
________________________ _________ _________________
City State Zip
______________________________________________________
Telephone
______________________________________________________
E-Mail
I certify that the information supplied on this application and on the attachments provided (maps and other information) is
accurate and true to the best of my knowledge. In addition, I hereby grant permission to the agents and employees of the City of
Harrisonburg to enter the above property for the purposes of processing and reviewing this application. I also understand that,
when required, public notice signs will be posted by the City on any property.
_____________________________ ________
PROPERTY OWNER DATE
Letter explaining proposed use & reasons for seeking comprehensive plan map amendment.
Survey of property or site map.
Traffic Impact Analysis (TIA) Determination Form OR Traffic Impact Analysis (TIA) Acceptance Letter signed by Public Works
Department. Applicant is responsible for coordinating with Public Works prior to submitting this application. For more information,
visit www.harrisonburgva.gov/traffic-impact-analysis.
TO BE COMPLETED BY PLANNING & ZONING DIVISION
Date
_____________________________________________________
Date Application and Fee Received
_____________________________________________________
Received By
Total Fees Due: $________________________
Application Fee: $550.00 + $30.00 per acre
