APPLICATION FOR FAMILY
DAY HOME (up to 12 children)
Town of Culpeper, Virginia
Department of Planning and Community Development
400 S. Main St., Suite 301 Culpeper, Virginia 22701
Phone: 540-829-8260 Fax: 540-829-8279
Application is hereby made for a family day home for up to 12 children.
Please submit a sketch plan or plat depicting the entire lot (Sec. 27-52(7)(a).
Tax Map Number:
Property
Owner:
Date:
Owner
Address:
Owner
Phone:
Owner
City/State/Zip:
Signature of Property Owner
or Authorized Agent:
Administrative Section - DO NOT WRITE BELOW THIS LINE
Zoning District:
Applicant:
Applicant
Address:
Applicant
City/State/Zip:
Applicant
Phone:
Playground Equipment On-Site
(Yes or No)
Playground Equipment Off-Site
(Yes or No)
Action
Taken:
Signature of Permit Issuing Authority
Comments/Remarks:
Number of
Employees:
Number of
Vehicles:
Drop off/Pick up Schedule:
Lot Area:
Family Day Home
Case Number:
Date Notice Mailed to
Adjacent Properties
Staff
Initials:
Signature of Applicant:
