MONTGOMERY CO VA TELECOM TOWER MODIFICATION CHECKLIST
SITE / PROPERTY
INFORMATION
Address:
City, State & Zip:
Tax Map #: Parcel ID # (6-digits):
Zoned: Date(s) SUP Approved & Amended:
OWNER(S)
INFORMATION
Name(s):
Address:
City, State & Zip:
AGENT
INFORMATION
Name: Service Provider:
Mailing Address:
City, State & Zip:
Telephone: Email:
Generals:
N
ame and address: 1) Land Owner 2) Tower Owner 3) Developer / Applicant 4) Person Preparing the Plan
2) # of Plan Sets ProvidedSite Plans: 1) Date of Plans ____________________ _______
Original date, revision date(s), scale of plan
Zoning District, Tax Map ID #, Parcel ID # (6-digits) and Address of Site
NOTE: For new structures and/or undeveloped properties, please contact the E-911 Address Manager.
Vicinity map at a scale not less than 1” = 2000’ and north arrow
Project description is provided
Add a sheet including the elevation view of the existing tower, height and location of all users and equipment on
the tower – Provide details of all equipment to be removed and/or added to the tower or site.
Add a sheet for inclusion of the Special Use Permit Resolution
Signature blocks and approval statements for the Zoning Administrator
Copy of the ordinance allowing special use permits and conditions with county approval date shown on plan
Submittals:
P
rovide (2) copies of the plans submitted for review and resubmittal plans
Provide (1) copy of an Exemption From Building Permit Request Form (Contact Inspections 540-382-5750)
Miscellaneous:
S
ite Development Plan Application
Payment of required REVIEW FEE ($20 Application Fee) AMOUNT SUBMITTED $__________________
Date Application Received:
_REVIEW DATE:REVIEWED BY:_______________________________________________ __________________________
Montgomery County Planning & GIS Services | 755 Roanoke St, Suite 2A | Christiansburg, Virginia 24073-3177
PHONE 540-394-2148 | WEBSITE MontgomeryCountyVa.gov | EMAIL mcplan@montgomerycountyva.gov
REVISED 01.08.2020 X: PlanningGIS>Planning>Forms>Checklist Page 1 of 1
