This form is required to be completed by any lessee of the LCYC Villa, prior to submitting a permit to the county. If no County permit is required, then the lessee shall complete this form prior to any construction or grading activity. An accurate and complete site plan is required to be attached, showing the lot dimensions, existing/proposed structures with setback distances from lot lines, and any area of grading (fill or removal). It is recommended that you use the same site plan for both the County Permit (if required) and this request. The required site plan information for the County is available online.

Applicant Information
Project Information
Have the surrounding lessees agreed to the lot boundary markers?