Application For Home-Based Business
Lorton Valley Homeowners Association
Application for Home-Based Business
Please fill out all areas completely.
Only complete applications will be reviewed.
Section I: Applicant Information
Name: ________________________________________________ Phone (W): ________________________ Phone (H): ________________________ Email: ________________________________________________ Property Address: ________________________________________________Section II: Proposed Home-Based Business
Name of Business: ________________________________________________ Type of Business: ________________________________________________ Anticipated # of customers/clients/visitors per day: ________________________________________________________(For child day care services, please state the number of children and whether your home is attached or detached.)
Will a company/corporate vehicle be maintained at the residence? If yes, describe vehicle (make/model/color/logo): ________________________________________________________ How many deliveries per week will you receive? ______________Section III: Attachments
- ☐ County Business License
- ☐ Applicable State Licenses
- ☐ Other Applicable Permits
- ☐ Exhibits, petitions, photographs, experts’ statements, etc.
Section IV: Applicant Signatures
I hereby certify that the information I have provided is accurate to the best of my knowledge. I further certify that, once approved, I shall conduct the proposed home-based business in accordance with Policy Resolution 14-02. Permission is hereby granted to members of the Lorton Valley Homeowners Association Covenants Committee, and its representatives, to enter on my property as necessary and with advance notice as part of its review of my application and as part of its responsibility to reasonably enforce Policy Resolution 14-02.Applicant Signature: ______________________________________ Date: ________________
Co-Applicant Signature: _________________________________ Date: ________________Please Return Completed Application To:
Covenants Committee Lorton Valley Homeowners Association c/o FirstService Residential 11351 Random Hills Road, Suite 500 Fairfax, VA 22030 Fax: 703-591-5785 Email: Randy.Kline@fsresidential.com