First Name *

Last Name *

Address *

City *

State *
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip *

Phone *

Email *

First Name

Last Name

Address

City

State
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip

Phone

Email

Property Address *

Tax Parcel ID No *

This can be found on your Northumberland County tax bill, or the Northumberland County Parcel Viewer.

Brief Description of Project *

Total Value of Project *

Has there been any recent development on this parcel of record?
YesNo

If yes, when and what was developed?

Current use of property:
ResidentialCommercialAgriculturalIndustrial

Total Lot Area (Sq. Ft. 1 acre = 43,560 sq ft)

Corner Lot:
YesNo

Proposed Building Size (Sq. Ft.):

Proposed Height:

Dimensions:

Existing Lot Coverage (Sq. Ft.):


Percent of Lot Area:

Proposed Lot Coverage (Sq. Ft.):


Percent of Lot Area:

Front Yard:


Left Side Yard:

Right Side Yard:


Rear Yard:

Are there any easements or deed restrictions
on your property?
Yes (please provide copy of deed if possible)No

Are there any environmentally sensitive features located on the property (wetlands/swales/floodplain)?
YesNo

Sewage Disposal System
Public SewerOn-Lot SepticOther

Other:

Water Supply
Public WaterWellOther

Other:

Current number of bedrooms
12345

Proposed number of bedrooms
12345

Require. Application will be declared incomplete without attaching Plot Plan.

A plot plan showing all existing improvements and proposed construction, including driveways, walkways, stormwater management features, easements, and utilities shall accompany this application. The plan shall include measurements of setbacks from all property lines and from the right-of-way of any road frontage on the property. Adjoining properties shall be labeled. Until such plan is submitted, this application shall not be considered complete and will not be processed.

If the proposed is a Business, Industry, Home Occupation, or a Change of Use of a new or existing building, please enclose a detailed description outlining the products sold, manufacturing process, services rendered, equipment to be used, floor areas of building, number of employees, and any other information that is necessary to thoroughly describe the proposed operation.