TOWN OF OCCOQUAN

314 Mill Street, PO Box 195

Occoquan, Virginia 22125
703-491-1918 FAX 703-(703) 491-4962

REZONING APPLICATION

Please print or type the following information:

Site Address: ________________________________________ Parcel # _____________________

Applicant: _______________________________________ Business Name: ____________________

Phone Numbers: Work: ______________ Home: ___________________ FAX: ________________

Address: __________________________________________________________________________

Owner: ____________________________ Phone: _________ FAX: _____________

Address: ___________________________________________________________________________

Size of Parcel: ____________S.F. Existing Zoning :___________ Historic Dist.? N/Y

Requested Zoning: __________________________________________________________________

Proposed Use: _____________________________ Proposed Floor Area of Use: ________________
If applicable, # Dwellings: __________________

Description of Intended Zoning Use (Attach Concept Plan, Proffer Statement and any other pertinent
information):
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
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Applicant's Signature: _____________________________________ Date: _________________

Owner's Signature: _________________________________ Date: ________________________

 OFFICE USE ONLY
Complete Application Received: ______ Fee Amount: _______ Date Paid: ______________
Planning Commission Hearing: _________________ Action: _______
 Approval Conditions of Approval: _____________________________________________

 Denial - Reasons:
___________________________________________________________________________
Town Council Hearing: _____ Action: ___  Approval Conditional Approval
__________________________________________________________________________________
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 Denial - Reasons:
__________________________________________________________________________________
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