Street Address Request Form

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					                              LANCASTER COUNTY, VIRGINIA


                                       Street Address Request Form
_________________________________________________________________

                                    Date: _______________________

     Due to the implementation of the Enhanced 911 telephone
service in Lancaster County, all occupied buildings are required
to have a street address assigned. Builders of new homes may be
required to provide this information to utility companies such as
Virginia Power, Northern Neck Electric Cooperative and GTE before
any service can be installed.

     In order to issue an address for a new home, please provide
the information as requested below. Once completed, return this
form to the Land Use Office at the time you apply for a building
permit or any time prior to making arrangements for utility
service.
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   Tax Map and Parcel Number: _______________________________

   Name of Applicant: _______________________________________

   Current Mailing Address: _________________________________

   City, State Zip: _________________________________________

   Phone Number: ____________________________________________

     In the space below, provide a drawing of the building lot
showing the proposed location of the house and other planned or
existing structures; the approximate distance of the house from
the property lines; and the location of the driveway. If a site
plan or other drawing of the proposed/existing structures exist,
you may substitute a copy in lieu of the drawing.     It is not
necessary that this drawing be to scale.




For Office Use Only:

Address Assigned: ____________________________ Date: ___________