Zoning Statement of Agricultural Exemption – Form 1200 Fill This Form Out Online or Scroll to the Bottom of this Page for a Printable Copy Zoning Statement of Agricultural Exemption - Form 1200 Zoning Statement of Agricultural Exemption - Form 1200 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 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:* Describe the type of proposed structure and size of structure*Will the structure accomodate animals?* Provide the type & number of animals here:Will the structure be placed on the same property (tax map number) as the agricultural operation?*Please select the correct response Is the property located in a floodplain?* Yes No Will the structure be in a floodplain?* Yes No If so is the floodplain elevation determined?* Yes No *The Setback questions below are for informational purposes only. The inability to meet setback requirements will not prohibit the structure if agricultural zoning exemption is determined.*Will the structure be placed at least 35 feet from the centerline of public road/street?**Will the structure be located at least 10 feet from all adjoining property lines?*The exemption of a Zoning Permit for agricultural purposes does not guarantee the agricultural exemption from the Building Department. Please complete the required paperwork for the Building Department. Separate codes apply to Building and Zoning and separate forms are required. The Grayson County Zoning Ordinance defines Agricultural Operation as: The use of land for agricultural purposes including but not limited to; the storage, handling, production, or sale of agricultural, horticulture, floriculture, silviculture. May include nurseries, greenhouses, crops, pastures, tillage of soil and orchards. To include the sheltering, raising, handling, processing or sale of agricultural and animal products and may include the use, maintenance and storage of machinery or equipment as part of the agricultural operation. Agricultural Buildings/Structures is defined as “used for agricultural purposes and not for residential or non-agricultural commercial or industrial uses and must be located on the same parcel where a bona-fide agricultural operation occurs. To be considered for the agricultural exemption from a zoning permit, the property owner must sign this affidavit: The proposed structure as indicated on this application meets the requirements for agricultural exemption as defined in the Grayson County Zoning Ordinance and listed above. Date* MM slash DD slash YYYY Signature (Property Owner):* Date* MM slash DD slash YYYY Witness:* I certify that all information listed on this application is true and correct to the best of my belief and knowledge. The determination of zoning agricultural exemption is based upon the information provided on this application; any false representation may null and void this determination. By signing this statement, I declare that the use of the structure(s) is for agricultural use only. I grant permission for an agent of the Building or Zoning department to visit my site for necessary review and inspections. I understand that false misrepresentation of agricultural use may result in the potential removal of the structure and/or a Notice of Violation in accordance with the Grayson County Zoning Ordinance. Date* MM slash DD slash YYYY Signature (Property Owner):* Download (PDF, 152KB)
