Land Development Services

Fairfax County, Virginia

CONTACT INFORMATION: Office hours: 8 a.m.-4:30 p.m. Counter hours: 8 a.m. – 4 p.m. (M-Th), 9:15 a.m.-4 p.m. (F)

TTY 711

12055 Government Center Pkwy
Fairfax, VA 22035

Bill Hicks,

Land Development Services Forms

Forms & Applications

Most forms from Land Development Services are available in PDF format. Some forms, as indicated, may be filled-out online prior to printing and/or must be submitted on legal size (8-1/2 inches x 14 inches) paper.

General Forms

Form Name Fillable Legal Size
Request for Records (FOIA)    
Building Code Appeals Application  
Building Code Modification Request Form  
Home Improvement Contractor (HIC) Application  
Builder's Application for Temporary Waiver  
Class IVB Soils Certification  
Conservation Agreement
Designated Plans Examiner Second Submission Plan Submittal Checklist (UFMD)    
Developer's Project Completion Checklist  
Driveway Agreement  
Dustless Surface Maintenance Agreement
Erosion & Sediment Control Checklist     
Floodplain Use Determination Request  
Geotechnical Final Report    
Geotechnical Submission Checklist    
Hold Harmless Form #1
Infill Lot Grading Plan Checklist    
Land Disturbance Application  
Landscape Deferral Agreement  
Lot Validation Request Form  
Maintenance Agreement for Stormwater Management Facilities on Private Properties  
Maintenance Agreement for Stormwater Management Facilities Located in a Public Right-of-Way  
Minor Site Plan Application Form  
Modified Processing Request Form    
Parking Reduction Agreement | Common Parking Reduction Approval Conditions    
Parking Tabulation Form | Instructions

Plan Coversheets:

Post Submission Conference Request Form  
Priority Rating Form for E&S Control  
Proposed Amendment to the Public Facilities Manual  
Record Plat and Final Subdivision Plat Checklist  
Request for Residential Use Permit  
Request for Waiver/Modification of the Provisions of Article 13 of Zoning Ordinance  
Request for Records (FOIA)  
Revision - Bond Block  
Rough Grading Plan Processing Review Checklist    
Simple Subdivision Eligibility Checklist  
Solar Energy Equipment Tax Exemption | Program Description  
Stormwater Management Plan Completeness Checklist  
Stormwater Rescission Agreement  
Waiver/Modification/Exception Request Form  

Inspection Forms

Form Name Fillable Legal Size
Backflow Notice of Inspection | Device Testers  
Ejector/Grinder Pump Request Form  
Electrical Inspection Report and Certification Form  
Elevator/Escalator Certificate of Compliance    
Request for Third Party Residential Inspections  
Sewer and/or Water Service Connection Agreement    
Sewer Video Submission  
Statement of Special Inspection  
Swimming Pool Electrical Inspection Report and Certification  
Vent/Chimney Certification  

Permit Forms

Form Name Fillable Legal Size
Affidavit for Demolition of Accessory Structures  
Affidavit of Permit Authorization  
Amusement Device Application  
Annual Permit Application  
Annual Permit Report and Certification  
ANSI Square Footage Certification  
Asbestos Inspection Certification  
Asbestos Removal Certification  
Bond for Demolition of Building  
Cancellation / Refund / Extension Request  
Elevator Permit Application and Supplemental Information  
Geothermal Certification  
Industrialized Building / Manufactured Home Affidavit  
Modified Processing Request Form    
Multiple-Family Residential Use Permit Application  
Owner / Developer Affidavit  
Permit Application  
Property Ownership Affidavit  
Sign and Building Permit Application   

Building Plan Review Forms

Form Name Fillable Legal Size
Antenna Certification Form  
Building Plan Review Cover Sheet | Checklist for Minimum Plan Submissions   
Footing and Foundation Permit Extension Application  
Residential HVAC Certification | Instructions  
Statement of Special Inspection  
Truss Plan Cover Sheet  
Waiver for Wall Mounted Signs  

Bonds and Agreements Forms

Form Name Original, double-sided print required Fillable Legal Size
Completion Agreement  
Conservation Agreement - Cash
Conservation Agreement - Letter of Credit
County and VDOT Street Inspection Process for Developers    
Developer’s Street Inspection Guidelines for Bond Release    
Development Agreement
Development Construction Schedule (sample only)      
Extension Request  
Future Construction Agreement  
Letter of Credit      
Letter of Credit - Conservation Agreement      
Letter of Credit - Extension Verification      
Letter of Credit - Extension Verification (Increase or Decrease in Bond)      
Letter of Credit - Tree Replacement Agreement      
Maintenance Agreement for Stormwater Management Facilities on Private Properties    
Maintenance Agreement for Stormwater Management Facilities Located in a Public Right-of-Way    
Performance Bond (Corporate Surety)
Performance Bond - Verification Certificate      
Pro Rata Share Agreement
Pro Rata Share Assessment (Effective Feb. 26, 2016)    
Sanitary Sewer Agreement  
Set-Aside Letter      
Set-Aside Letter - Bank Extension      
Site Inspection Fee Estimate Worksheet (.xlsx)      
Street Inspection Guideline      
Surety Value Estimate (.xls)    
Tree Replacement Agreement    

Chesapeake Bay Preservation Ordinance Forms

Form Name Fillable Legal Size
Exception Request Form & Water Quality Impact Assessment-Minor Additions  
Exception for Public Hearing (RPA)  
Chesapeake Bay Preservation Ordinance Exemption/Exception Request
Removal of Vegetation in a Resource Protection Area Application  

VPDES General Permit Coverage Forms

Form Name Fillable Legal Size
Registration Statement    
Notice of Termination    
Transfer Agreement    
State Permit Fee Form    

BMP Inspection Checklists and Certifications

Form Name Fillable Legal Size
Constructed Wetland    
Dry Swales    
Extended Detention Pond    
Filtering Manufactured Devices    
Filtering Practices    
Grass Channel    
Hydrodynamic Manufactured Devices    
Infiltration Practices    
Permeable Pavement    
Rainwater Harvesting    
Rooftop Disconnection    
Sheet Flow    
Soil Compost    
Vegetated Roof    
Wet Pond    
Wet Swale    

Related Forms

Your project may require the completion of additional forms as well.