Bath County, Virginia

Resident:

Email:

Phone Bill Name:

Current Mailing Address:

Address Line 2:

Phone Number - Include separate lines for data:

Landlord's Address:

Structure Information: Check one
New BuildingExisting BuildingReplacement BuildingOther

Tax Map Number:Building Permit #:

Road Name:NewOld

Driveway Entrance
Uses Existing - YesNo

Latitude (N):

Longitude (W):

Structure Front Door

Latitude (N):

Longitude (W):

Sketch - make sure to include landmarks and adjacent addresses.

New Address: