Land Use/Development Application

County of Camden, North Carolina

Please Do Not Write in this Box

PIN:

_______________________________

UDO#_________ - _______- _______

Date Received: __________________

Received by: ____________________

Zoning District: __________________

Fee Paid $ _______________________

Depending upon the type of proposal, the proposal may require a Zoning Permit, Conditional Use Permit, or Special Use Permit. This form is used as the start of application process. All applicants must submit a site plan (see “Minimum Site Plan Requirements”) and a valid Health Department permit. Applicants for a Conditional Use Permit or Special Use Permit should review the “Requirements for Conditional Use Permit and Special Use Permit Applications”).

Applicants for a subdivision must submit this form as their Special Use Permit application.

Please consult the Planning Office (1-252-338-1919) with any questions about your application.

PLEASE PRINT OR TYPE

Applicant’s Name: ______________________________________________

If the Applicant is acting as agent for another person (the “principal”), please give that

person’s name on the line below and submit a copy of the agency agreement/letter with this Application.

___________________________________________________

Applicant’s Mailing Address: ______________________________________

_______________________________________

_______________________________________

Daytime Phone Number: (________) ________________________________

Street Address Location of Property: ___________________________________________________________

General Description of Proposal: _____________________________________________________

__________________________________________________________________________________

I swear or affirm that the foregoing information and all attachments hereto (now or subsequently provided as part of this application) are true and correct to the best of my knowledge.

Signed: ___________________________________

Dated: ___________________________________

* Information to be filled out by Planning Department

*Is the Property in a Watershed Protection area? ________________________________________

*Flood Zone (from FIRM Map): ____________________ *Taxes paid? yes ____ no _____