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Request for Preliminary Assessment Form

Office of Historic Alexandria
ALEXANDRIA ARCHAEOLOGY
105 N. Union Street, #327
Alexandria, Virginia 22314
Tel: 703-838-4399
Fax: 703-838-6491

Form completion required for compliance with the Archaeological" Protection Code, included in Zoning Ordinance, Section 11-411(D), 1992.

Project Name:_______________________________

Date: ___________

Address:____________________________________________________

Tax Parcel Number: __________________________________________

Applicant: _____________________________Phone:_______________

Owner: _______________________________Phone: ______________

Address:___________________________________________________

Contact: ______________________________Phone: _______________

Address: ___________________________________________________

Project Actions:

1. [ ] Demolition

2. [ ] New Construction

3. [ ] Addition

4. [ ] Restoration/Renovation

5. [ ] Landscaping

6. [ ] ______________________________

Description of Project:(attach additional pages if necessary)

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Submit a map showing the exact location of your property. If available please attach the following: maps showing existing structures, proposed demolition (if any) and construction; chain of title, historic maps; previous historical or archaeological research.

This form will be signed and returned to you with our recommendations within seven days of receipt. Submit a copy of the form signed by the City Archaeologist with your preliminary site plan when you file with the City.

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