Rev. 8/14
TOWN OF MIDDLEBURG
10 West Marshall Street, PO Box 187
Middleburg, Virginia 20118-0187
540-687-5152 FAX 540-687-3804
APPLICATION
Vacation or Adjustment
of Boundary Lines or Plat
Type Application: Vacation or Adjustment of Boundary Lines (BLA) Vacation of Plat (VAC)
Applicant Name: Phone #:
Mailing Address: email:
The attached plat and/or deed describe the vacation of a plat or the relocation, alteration, adjustment or vacation
of boundary lines of the following affected properties (Owner Name and Mailing address as appear in the land records):
Affected Property Address: Parcel #:
Subdivision Name: Lot #: Zoning District:
Owner Name: Phone #:
Mailing Address: email:
Affected Property Address: Parcel #:
Subdivision Name: Lot #: Zoning District:
Owner Name: Phone #:
Mailing Address: email:
continuation sheet attached (if additional properties involved)
The attached materials certify that all affected owners have acknowledged their agreement to file and execute this
application. If this is a boundary line adjustment, I also certify that this application does not involve the relocation or
alteration of streets, alleys, easements for public passage or utilities, or other public areas, and that no easements or utility
rights-of-way will be relocated or altered without the express consent of all persons holding an interest therein. I
acknowledge responsibilty for all applicable fees per the Town’s adopted fee schedule, which may include a base fee due at
the time of application and additional review fees to be billed later.
Applicant Signature: Printed Name:
OFFICE USE ONLY
Date Filed: Fee amount: Date Paid: Application #:
Approved: Date: _ Recorded: _____________
Zoning Administrator
THIS APPROVAL EXPIRES 6 MONTHS FROM THE APPROVAL DATE IF THE PLAT AND DEED ARE NOT PROPERLY RECORDED
AMONG THE LOUDOUN COUNTY LAND RECORDS.
