Shoreline Recreation Zone District Application – Form 1100 Fill This Form Out Online or Scroll to the Bottom of this Page for a Printable Copy Shoreline Recreation Zone District Application - Form 1100 Shoreline Recreation Zone District Application - Form 1100 Department of Planning and Zoning P.O. Box 217, Independence, VA 24348 Phone: 276-773-2471 Fax: 276-773-3673 www.graysoncountyva.govName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Name of Property Owner* First Last Tax Map Number:* 911 Address/Site* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Area or Acreage of Parcel:* Describe the type of proposed structure* List proposed use(s) of the new structure. *Residential & Commercial uses are not allowed in this Zone District*Has the site been marked with flagging? Show the building location & dimensions on the site.* YES If Building Site is not marked, application will not be accepted File Upload for Showing the building location & dimensions on the site.Max. file size: 100 MB.Provide Building Dimensions. Provide the Square Footage of the Roof Area. Or N/A if no roof is plannedBuilding Dimension* Roof Area* Will the structure be in the FEMA Floodplain?* Yes No If not in the floodplain you must show this with an elevation determination or you can choose to meet the floodplain development requirements listed below.Is the “No-Rise Certificate” attached?* Yes No Floodplain Development- Must provide No Rise Certificate with the applicationFile upload for no-rise certificateMax. file size: 100 MB.Will the structure be properly anchored?* Yes Describe Anchoring Technique* Will the structure have any walls?* Yes- One Wall (Only structures with less than one wall allowed.) No Solid Wall cannot impede floodwater flow direction.Will Flood resistant materials be used?* Yes- Only Flood Resistant Materials can be used in the Floodplain. No IF Proposed Structure is not in the FEMA Floodplain – Complete this section.*Is the Base Flood Elevation Determination Attached to the application?* Yes No A Base Flood Elevation Determination is required for storage sheds and for any structure that will not meet the Floodplain Development Requirements.Is the Base Flood Elevation Determination Attached to the application?* Yes No File Upload for Base Flood Elevation Determination*Max. file size: 100 MB.Will the structure be located at least 35 ft. from the centerline of any public street?* YES- All Structures must meet this street setback requirement. Is this application for a carport type structure used to cover a recreational vehicle?* Yes No All Carport structures must show a mobility plan. Please attach the mobility plan to this application. Mobility Plan must meet Article 4-13.13 of the Zoning Ordinance.What is the proposed height of the structure from the nearest adjacent grade? Height shall be measured from the tallest point of the structure and measured to the base of the structure at ground level.The River Setback is 50 ft. from the river bank edge for all structures.Can this structure meet the River Setback?* Recreational Vehicles All Recreational Vehicles must be “Highway Ready” and cannot be attached to any structures. Administrator will not permit development if recreational vehicles located on the lot are not highway ready. Highway ready is defined as “having wheels & tires, a functional towing mechanism or the ability to be self-propelled, not attached to other structures and quick disconnect type utilities.” Only two (2) R.V’s are allowed on any lot. The Zoning Administrator will visit the site to verify the zoning requirements are met. Please indicate the completion date of this project. The Zoning Administrator will visit the site after this date to insure zoning compliance.Date of project completion:* MM slash DD slash YYYY To apply for a zoning permit a site plan sketch on an aerial map (google earth or county GIS) or legal survey must be submitted with this application. 1) Please show the proposed structure in relationship to primary access road or right of way. 2) Please depict the property lines on all sides of the property. Please show the location of the new structure in relationship to each of these property lines and include the distance in feet where the new structure will be from each of these property lines. Use arrows to show the distance in feet from all sides to all property lines. 3) Please show the distance of the new structure to the centerline of the public road or street by showing this distance in linear feet from the structure to the centerline of public road or street. 4) If any existing structures are located on the parcel please show them on the sketch. 5) If the parcel is located in a floodplain please show the floodplain in relationship to the new structure. 6) If the mobility setback/mobility plan applies, please show this on the sketch. 7) Please show the structure and the river setback in lineal feet.Please attach the site plan here.*Max. file size: 100 MB.I certify that all information listed on this application is true and correct to the best of my belief and knowledge. The approval of a zoning permit is based upon the information provided on this application; any false representation may null and void this permit. By signing this application I grant permission for an agent of the building or zoning department to visit my site for necessary review and inspections. I understand that any non-compliance may result in potential removal of the structure or a Notice of Violation in accordance with the Grayson County Zoning Ordinance.Date* MM slash DD slash YYYY Signature* Download (PDF, 165KB)
