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T-26-001 (Clark) PITTSYLVANIA COUNTY Zoning Ordinance Text Amendment Application Community Development Office 53 N. Main Street P. O. Drawer D Chatham, VA 24531 (434) 432-1767 Pittsylvania County Zoning Ordinance Text Amendment Application (August 2026) Page 2 of 4 COMMUNITY DEVELOPMENT P.O. Drawer D • 53 N. Main Street Chatham, Virginia 24531 Phone (434) 432-1767 Email: permits@pittgov.org Applicant Information Applicant Name(s): Mailing Address: City / State / Zip: Phone: Email: Proposed Text Amendment Zoning Ordinance Section(s) to Amend: Exact Wording of Proposed Amendment (A clean version may also be attached.): Has the Board of Supervisors acted on the same or a substantially similar amendment within the past 12 months? ☐ Yes ☐ No Applicant Certification I hereby certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that attendance at public hearings (Planning Commission and Board of Supervisors) is required. Applicant Signature (Notarized): Print Name: Date: Notary Acknowledgment: Sworn to and subscribed before me in my presence this _____day of __________,_____, in my City and State aforesaid, by Notary Public. My commission Expires:______________________ Pittsylvania County Zoning Ordinance Text Amendment Application (August 2026) Page 3 of 4 Statement of Justification Please provide a brief explanation addressing the following: 1. Purpose of the amendment: 2. Why the amendment is needed: 3. How the amendment supports good zoning practice, public welfare, or clarity: 4. Any additional background or supporting information (optional): Application Intake & Completeness Checklist – Staff Use Only Case No.: Date Received: Complete Application? Yes ☐ No ☐ Fee Paid: PC Hearing: BOS Hearing: Action: Approved ☐ Denied ☐ Deferred ☐ Pittsylvania County Zoning Ordinance Text Amendment Application (August 2026) Page 4 of 4 VIRGINIA: BEFORE THE BOARD OF SUPERVISORS OF PITTSYLVANIA COUNTY PETITION FOR ZONING ORDINANCE TEXT AMENDMENT TO THE HONORABLE SUPERVISORS OF PITTSYLVANIA COUNTY WHEREAS, your Petitioner, , respectfully files this petition pursuant to Sections 35-803 through 35-807 of the Pittsylvania County Zoning Ordinance and in accordance with the Code of Virginia 1950, as amended, and requests consideration of the following amendment to the text of Chapter 35. 1) Petitioner proposes that the Pittsylvania County Zoning Ordinance be amended as follows: (Identify Article, Division, Section, Subsection and include exact proposed text.) 2) Purpose of the Amendment: (Explain the purpose, justification, and intended effect of the amendment.) WHEREFORE, Your Petitioner respectfully requests that this petition be referred by the Zoning Administrator to the Pittsylvania County Planning Commission for public hearing and recommendation, and thereafter to the Pittsylvania County Board of Supervisors for final action. Respectfully submitted, Petitioner Sworn to and subscribed before me in my presence this _____day of __________,_____, in my City and State aforesaid, by Notary Public. My commission Expires:_____________________