Replace Manufactured Home Application – Form 0900 Fill This Form Out Online or Scroll to the Bottom of this Page for a Printable Copy Replace Manufactured Home Application - Form 0900 Replace Manufactured Home Application- Form0900 Department of Planning and Zoning P.O.Box217, Independence,VA 24348 Phone: 276-773-2471 Fax: 276-773-3673 www.graysoncountyva.govThis form is required when a manufactured home is replaced with a new home. The purpose of this form is to ensure compliance with Article 3-10 of the Grayson County Zoning Ordinance. The Property Owner must complete this form 0900 and the Zoning Application Form 0100 prior to issuance of the Zoning Permit for the new home.Name* First Last Mailing 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 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 Area or Acreage of Parcel* Please read each of the statement and choose the section that applies. Sign where required.The old Manufactured Home will be removed from the site within 180 days of the date on the application. Yes No If plans are to remove the old manufactured home, will it be dismantled or moved to another lot. Please indicate which here: Dismantled manufactured homes will require a Demolition Permit. Movement of the old manufactured home to a different site will require permit for placement at another lot/site if within GraysonCounty. I understand that failure to remove the old manufactured home or failure to properly reset the home within 180 days of this date, will be in violation of the Grayson County Zoning Ordinance Article3-10. Sign Here* Date* MM slash DD slash YYYY If manufactured home is to be removed or dismantled within 180 days this section does not apply. This section applies to homes reset on the same lot.Old Manufactured Homes that are reset on the same lot for residential use. 1) Residential Use – Older manufactured homes reset on the same lot must meet Article 3-7 and Article 3-8 of the Zoning Ordinance. Can the home meet the access and density requirements? Yes No 1) Residential Use- Manufactured home must be reset in accordance with the Grayson County Building Codes, Zoning Ordinance and Health Department Requirements. I understand the requirements forpermits and placement of the manufactured home on the same lot. I understand that proper reset of the manufactured home must occur within 180 days.Signature* Old manufactured homes that are reset on the same lot for accessory use. 1)Accessory Use -reset the manufactured home on the same lot for an accessory use. The Building Official must approve the change in use from residential to accessory use and the manufactured home must be properly set up with a zoning and building permit. I understand that the reset of the manufactured home must occur within 180 days.Signature* Building Official Comments for reset of manufactured home as an accessory use: The Zoning Administrator will visit the site to insure zoning compliance. Is there open access? Date of project completion: MM slash DD slash YYYY 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 of Property Owner* Use and Density Confirmed Download (PDF, 152KB)
