Fillable General Information (Clarke County Government)

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General Information (Clarke County Government)

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U.S.A. forms for Clarke County Government

BROWSE CLARKE COUNTY GOVERNMENT (VA) FORMS

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General Information
Date:
Tax ID#:
Zoning District:
Lot Size:
Site Address:
Property Owner’s Name:
Property Owner’s Mailing Address:
Applicant’s Name:
Applicant’s Mailing Address:
Phone:
Email:
Proposal Description
Describe the proposed use and structures, then select the appropriate categories listed below.
New Single Family Dwelling
Change of Use
Electric
Garage, Attached
Remodel
Plumbing
Garage, Detached
Deck with Roof
Bathroom
Addition, Heated
Deck without Roof
Kitchen
Addition, Unheated
Agricultural (add form)
Bedroom(s)
Storage Shed
Pool, above-ground
Other:
Pool, in-ground
Proposed Setbacks & Height
Complete all applicable blocks for proposed project. Write N/A if not applicable.
Measured to the closest point
Provided (Actual)
(Distance in Feet)
Required (Ordinance)
(Distance in Feet)
Front Property Line
Side (Right) Property Line
Side (Left) Property Line
Rear
Edge of Private Access Easement
Springs/Sinkholes/Perennial Streams
100 Feet
Intermittent Streams or Wetlands
Depends on District ( )
Maximum Height
Maximum Impervious Surface
Well Setback
(See Clarke County Code Ch. 184)
50 Feet – All Structures
100 Feet – Termite Treated
Zoning Permit Application
Zoning Permit Application (continued)
Additional Property Information
Flood Plain District
Yes
No
Historic District
Yes
No
Certificate of Appropriateness (if Yes, provide documentation of approval)
Yes
No
Conservation Easement (if Yes, provide documentation of approval)
Yes
No
Conservation Easement Holder Name:
Public Water
Yes
No
Public Sewer
Yes
No
Private Well (Contact utility for Information)
Yes
No
Onsite Septic System (Contact Health Dept. for Information)
Yes
No
Site Sketch
A site sketch is required. The
required site sketch must
accurately show all existing lot
features as well as the proposed
structure(s) and/or use(s) with
measurements provided to the
closest points of ALL applicable
items noted on Page 1 of this
permit application. In addition to
those items, measurements must
also be provided to the septic tank,
septic system, and any utility,
drainage, or other easements. All
required setbacks and information
must be shown prior to approval.
Survey plats may be found at the
Clarke County Circuit Court.
County GIS maps can be found at
https://mapsonline.net/clarkecounty.
Signature of Applicant
Date
Office Use Only
ACTION TAKEN: _________________________________________ FEE: _______________________________ DURs USED: ____________________
COMMENTS: __________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Zoning Administrator
Date
GIS Acct #
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General Information (Clarke County Government)

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Completed 17 April 2021

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