SPECIAL USE PERMIT MINIMUM SUBMISSION REQUIREMENTS CHECKLIST

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP88-01418R000200130006-2
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 11
• Document Creation Date: December 22, 2016
• Document Release Date: May 31, 2011
• Sequence Number: 6
• Content Type: MISC

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COUNTY OF PRINCE WILLIAM PLANNING
I County Complex Court, Prince William. Virginia 22192-9201 OFFICE
[phone] Metro 631-1703
FILE NO.:
Roger W. Snyder
Director
SPECIAL USE PERMIT MINIMUM SUBMISSION REQUIREMENTS CHECKLIST
ALL INFORMATION MUST BE COMPLETED IN ITS ENTIRETY, OR AN EXPLANATION MUST BE PROVIDED IN
THE COMMENT SPACES. OTHERWISE THE APPLICATION WILL NOT BE ACCEPTED FOR FURTHER
PROCESSING. COPIES OF WAIVERS OF SUBMISSION REQUIREMENTS APPROVED BY-THE DIRECTOR OF
PLANNING MUST BE INCLUDED WITH THE APPLICATION PACKET. -
TO BE COMPLETED BY THE APPLICANT
PROJECT NAME/PROPOSED USE : OTI HOPEWELL GAP MICROWAVE REPEATER SITE
Address: 1033 N.- Fairfax St Suite 404 Alex VA Tax Map(s): 154-((1))-P/O hot '1
Owner(s):Oyerseas Telecommunications Inc. Telephone,No.:703-?39-2672
Applicant/Authorized Agent: Daniel A. Wallace Telephone No. 703-739-2672
Engineer/ Surveyor: Daniel A. Wallace Telephone No.":'703'-739-2672
Attorney: Smith and Davenport Telephone No.: 703-368-8148
Signature of Person Completing Checklist: Date:
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TO BE COMPLETED BY PLANNING OFFICE PERSONNEL
Date Received:
Reviewed By:
Date Reviewed:
Date Accepted/Not Accepted:
Reason(s) For Not Accepting:
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SPECIAL USE PERMIT MINIMUM SUBMISSION RE UIREMENTS CnrC}:~` Page 2
CHECKLIST TO BE COMPLETED BY THE APPLICANT
AFTER THE APPLICATION PACKET AND CHECKLIST IS SUBMITTED TO THIS OFFICE, PLANNING OFFICE
PERSONNEL WILL REVIEW THE MATERIALS TO VERIFY THAT ALL APPLICATION INFORMATION IS ACCURATE
AND ALL MINIMUM SUBMISSION REQUIREMENTS HAVE BEEN MET.
1. J] j] j] A. FOUR (4) COPIES OF THE STANDARD APPLICATION FORM
NAME OF OWNER(S) OR (DESIGNEE*)
TITLE
'TELEPHONE NUMBER
TAX MAP REFERENCE
MAGISTERIAL DISTRICT
PROPERTY ADDRESS
ZONING-ORDINANCE SECTION NUMBER
INTEREST
ACREAGE
NAME, TELEPHONE NUMBER AND CURRENT ADDRESS OF
ALL OWNERS OF THE PROPERTY, WITH A 10% OR MORE
FULL EXPLANATION OF THE PURPOSE OF THE
APPLICATION
APPLICANT'S COMMENTS: STAFF COMMENTS:
m E] M B. POWER OF ATTORNEY FORM (IF APPLICABLE)
YES NO N/A
El ED Ej
NAME OF OWNER/AUTHORIZED AGENT
NAME OF DESIGN;FE/'A TCRNEY-IN-FACT
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YES NO N/A
1 " 1 B. POWER OF ATTORNEY FORM* (Continued)
APPLICANT'S COMMENTS:
YES NO N/A
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2. JJ [J [ THREE (3) COPIES OF A NOTARIZED AFFIDAVIT STATING THAT NO MEMBER
OF THE BOARD OF COUNTY SUPERVISORS OR PLANNING COMMISSION HAS AN
INTEREST IN THE PROPOSAL
APPLICANT'S COMMENTS:
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EFFECTIVE DATE
SIGNED BY PRINCIPLE OR AUTHORIZED AGENT
NAME OF COUNTY
DATE OF SWORN STATEMENT _
SIGNATURE OF NOTARY
NOTARY'S COMMISSION EXPIRATION DATE
STAFF COMMENTS:
El 0 D SIGNATURE OF NOTARY
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DATE
NOTARY'S COMMISSION EXPIRATION DATE
STAFF COMMENTS:
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SPEC:AL USE PEP-MIT MINIMUM SUBMISSION REQUIREMENTS CHECKLIST Page 4
0
D D
THREE (3) COPIES OF A NOTARIZED AFFIDAVIT STATING THAT NO MEMBER
OF THE BOARD OF COUNTY SUPERVISORS OR PLANNING COMMISSION HAS AN
INTEREST IN THE PROPOSAL (Continued)
APPLICANT'S COMMENTS: STAFF COMMENTS:
APPLICANT'S COMMENTS:
THREE (3) COPIES OF THE LATEST DEED(S)
STAFF COMMENTS:
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D El. D B. THREE (3) COPIES OF AN ACCURATE PLAT OF THE PROPERTY PREPARED BY
A CERTIFIED LAND SURVEYOR OR LICENSED CIVIL ENGINEER
BEARINGS AND DISTANCES FOR ALL PROPERTY LINES
AND EXISTING AND PROPOSED ZONING DISTRICT LINES
AREA OF LAND PROPOSED FOR CONSIDERATION, IN
SQUARE FEET OR ACRES
NAMES OF BOUNDARY ROADS OR STREETS AND WIDTHS
OF EXISTING RIGHTS-OF-WAY
ALL EASEMENTS OR ENCUMBRANCES (IF APPLICABLE)
APPLICANT'S COMMENTS: STAFF COMMENTS:
12,OIA)6' ;09- YO P-.
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SPECLk USE PERMIT !'!INIMU? SUBMISSION R_EQ? I?.EMENTS Page 5
4. D EJ D
APPLICANT'S COMMENTS: STAFF COMMENTS:
APPLICANT'S COMMENTS:
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THREE (3) COPIES OF THE WRITTEN BOUNDARY DESCRIPTION OF THE LANL
WHICH IS THE SUBJECT OF THE APPLICATION, CONFORMING TO THE PLAT
INFORMATION
THE CURRENT REAL ESTATE TAX ASSESSMENT BOOKS
FAMES, MAILING ADDRESSES, AND TAX MAP NUMBERS OF ALL PROPERTY
OWNERS LOCATED WITHIN 200' OF THE SUBJECT PROPERTY, AS LISTED
STAFF COMMENTS:
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IMPACTS TO ADJACENT USES SUCH AS THOSE RELATI?
TO NOISE OR LIGHTING OR SIGHT
NUMBER OF EMPLOYEES, AND ESTIMATED NUMBER OF
PATRONS PER DAY
}; IMPACT MITIGATION
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SPECIAL USE PERMIT RE?" - _-EX CHECKLIST Page 6
WRITTEN TEXT DESCRIBING: (Continued)
APPLICANT'S COMMENTS:
i^' D OTHER INFORMATION PERTINENT TO THE REVIEW OF THE
r-71 E]
PROPOSAL
APPROPRIATE SCALE. (THE DEGREE OF DETAIL, OR THE POSSIBILITY OF
WAIVER OF THIS REQUIREMENT IS LARGELY DEPENDENT ON THE PARTICULAR
PROPOSAL). WAIVER APPROVALS MUST BE ATTACHED TO THIS''CBECKLIST.
TWENTY (20) COPIES OF A SCHEMATIC SITE PLAN, DRAWN 20?`AI
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STAFF COMMENTS:
TOTAL AREA OF THE PROPERTY IN SQUARE FEET OR
ACRES
PLAN DRAWN TO SCALE
NORTH REFERENCE (ARROW)
TAX MAP REFERENCE
LOCATION AND DIMENSIONS OF ALL EXISTING ON-SITE
BUILDINGS
STRUCTURES
TRAVEL WAYS
PARKING SPACES
EASEMENTS
POINTS OF INGRESS AND EGRESS
D D Til
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El D tJ
1 E El
LOCATIONS AND DIMENSIONS OF ALL PROPOSED:
BUILDINGS
STRUCTURES
TRAVEL WAYS
PARKING SPACES
EASEMENTS
POINTS OF INGRESS AND EGRESS
DIMENSIONS OF ALL YARDS. BUILDING, PARKING
SETBACKS
FRONT
SIDE
REAR
INDICATION OF HOW ADJACENT AND NEIGHBORING
PROPERTIES WILL BE PROTECTED FROM ANY ADVERSE
IMPACTS CAUSED BY THE PROPOSED USE:
LOCATIONS AND DIMENSIONS OF PROPOSED SCREENING
LOCATIONS AND DIMENSIONS OF PROPOSED FENCING
LOCATIONS AND DIMENSIONS OF PROPOSED BUFFER
APPLICANT'S COMMENTS:
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LOCATIONS AND DIMENSIONS OF PROPOSED UNDISTURB
AREAS
LOCATION OF WELL(S)
LOCATION OF SEPTIC SYSTEM
INDICATION OF HOW PROPERTY WILL BE SERVED BY
PUBLIC FACILITIES (SEWER AND WATER)
STAFF COMMENTS:
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SPECIAL USE PERMIT MINLMUM SUBMISSION RE,u:RL'-E*'_ Cs?E Y-_==- Page 8
TWENTY (20) COPIES OF A SCHEMATIC SITE PLAN, DRAWN TO AN
APPROPRIATE SCALE. (THE DEGREE OF DETAIL, OR THE POSSIBILITY OF
A WAIVER OF THIS REQUIREMENT IS LARGELY DEPENDENT ON THE
PARTICULAR PROPOSAL). WAIVER APPROVALS MUST BE ATTACHED TO THIS
CHECKLIST.
(Continued)
APPLICANT'S COMMENTS: STAFF COMMENTS:
APPLICANT'S COMMENTS:
APPLICANT'S COMMENTS:
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SPECIAL USE PERMIT FEE(S)
SERVICE AUTHORITY REVIEW
OTHER
STAFF COMMENTS:
CONCURRENT PROCESSING OF ZONING/SITE PLAN (IF APPLICABLE)
OWNER'S NAME (SIGNATURE)
OWNER'S ADDRESS
STAFF COMMENTS:
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Next 5 Page(s) In Document Denied
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