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2. Applicant / Client Contact Information
4. Last Name:*
5. First Name:*
6. Middle:
8. Address:*
10. City:*
11. State:*
12. Zip Code:*
14. Primary Phone: *
16. Secondary Phone:
18. Email Address:*
20. Preferred Means of Contact:

    1. Phone Contact (Primary Phone Provided Above)
    2. Email (Provided Above)
    3. In Office of Land Development Meeting
    4. Field Meeting (Specify Below)
22. Location of Field Meeting:
24. Applicant / Client Availability Date/Time
26. Option #1 Date*
27. Option #1 Time:*
29. Option #2 Date:
30. Option #2 Time:
32. Option #3 Date:
33. Option #3 Time:
35. Reason for Contact:
37. Category:

    1. Building Permit
    2. Grading Permit
    3. Occupancy Permit
    4. Mapping
    5. Rezoning
    6. Subdivision (Lot Creation)
    7. E911 Location Address
    8. Zoning Certification
    9. Board of Zoning Appeals
    10. Building Code
    11. Floodplain Management
    12. Document Request
    13. General Assistance
    14. Code Enforcement
    15. Other
39. Address for Topic:
41. Brief Description (Narrative):
43. Upload Attachment (Image, PDF)
45. If you have received no response from the LDS office within 2 days of your request submittal, please contact LDS at 301-777-5951.
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field