Forms, Permits, and Applications

Departments

Boards and Commissions

Title	Attachments	Submit Online
01. Administration Policies and Forms	Form 1.3 - Ambulance Fee Waiver Request (2021) Form 1.4 - Historic Courthouse Use Application Form 1.8 - Freedom of Information Act Request Office Move Request Form Photo Submission and Release Form EMS Cost Recovery Trifold Brochure (2021) EMS Cost Recocery FAQs (2018) EMS Cost Recovery Notice of Privacy Practices (2021)
02. Personnel Policies and Forms	Form 2.3a -Fluvanna County Employment Application Form 2.5a - Employee Separation or Transfer Checklist Form 2.5b - Personnel Action Request Form 2.7 - Employee Performance Evaluation Form 2.13 - Leave Sharing Form 2.14 - Family and Medical Leave Act Application Form 2.17a - Employee Grievance Form 2.17b - Employee Grievanance Review Panel Form 2.20 - Workers Compensation Panel of Physicians VRS Information Change Form VRS Request for Member Information Form Direct Deposit Authorization Form 2.19 - Travel and Business Expenses (updated Jan 2024)
03. Finance Policies and Forms	Form 3.2 - Wire Request Form 3.3a - Payment Voucher Form 3.10 - Capital Reserve Maintenance Fund Request Form 3.11a - Fluvanna County Voluntary Contributions Form 3.11b - Fluvanna County Voluntary Contributions Rejection Form W9 - Request for Taxpayer Identification Number and Certification
04. Procurement Policies and Forms	Form 4.3 - Surplus Property Determination Form 4.5a - Purchase Card Application/Agreement Form 4.5b - Purchase Card Maintenance Request Form 4.5c - Purchase Card Log Form 4.6 - Fuel Card Dispute Small Purchase Quotation Form
Absentee & Early Voting Forms
Adopt-A-Spot Program	Program Application Adopt-A-Spot Program Report Form
Agreement in Lieu of Erosion & Sediment Control Form	Agreement in Lieu of Erosion & Sediment Control
Agricultural & Forestal District Application Form	ag_forestal_district.pdf
Antenna Modification Application Form	Antenna Modification Application
Application for Building Permit Form	application_updated.pdf
Application for Mechanical, Electrical, And/Or Plumbing Permit Form	mep_permit_application.pdf
Board of Zoning Appeals - Interpretation of District Map Form	Board of Zoning Appeals - Interpretation of District Map Form
Board of Zoning Appeals-Variance Application & Checklist	Variance Application & Checklist
Boundary Adjustment Application Form	Boundary Line Adjustment Application
Boundary Modification & Survey Forms
Business Personal Property	2024 Business Personal Property Form
Capital Reserve Maintenance Fund Request	Capital Reservce Maintenance Fund Request Form
Community Event Notification		Submit Online
Community Garden	2024 Community Garden registration
Comprehensive Plan (2015)	Comprehensive Plan (2015)
Conservation Easement Checklist and Application Form	Conservation Easement Checklist Conservation Easement Application
County Fair	Vendor application Home Arts Schedule of events Fair guide
County of Fluvanna Employment WEBFORM Application		Submit Online
Crime Tips		Submit Online
Customer Satisfaction Survey	Customer Satisfaction Survey
Deed Template	Deed Template
Doing Business with Fluvanna
Easement/Boundary/Physical Survey Application	Easement/Boundary/Physical Survey Application
Employee Appreciation & Recognition Program - IMPACT	IMPACT Recognition Form- For Print	Submit Online
Employee Notification System Overview and Registration		Submit Online
Erosion and Sediment Control Checklist Form	Erosion and Sediment Control Checklist Form
Erosion and Sediment Control Forms	e_s_fees_2024.pdf Erosion and Sediment Control Ordinance
Exemption of Farm Buildings or Structures from The Virginia Uniform Statewide Building Code Form	Exemption of Farm Buildings or Structures from The Virginia Uniform Statewide Building Code
Family Subdivision Application	Family Subdivision Application
Family Subdivision Checklist	Family Subdivision Checklist
FAN Mail Submission Form		Submit Online
Federal Post Card Application (FPCA)	Voter Registration and Absentee Ballot Request Federal Post Card Application (FPCA)
Fire and Rescue Volunteer Recruitment		Submit Online
Fluvanna County Interagency Council - Partner Organizations
Fluvanna County Voluntary Event Form		Submit Online
Fluvanna Volunteers
Form 1.2 - Community Service Certificate Nomination Webform		Submit Online
Form 1.8 - Virginia Freedom Of Information Act (VFOIA) Request For Records Webform		Submit Online
Fuel Card Dispute Form	Fuel Card Dispute Form
GIS Distribution Policy Application	GIS Distribution Policy Application
Land Disturbing Application Form	Land Disturbing Permit Form
Land Use Application	Land Use Application Instructions Land Use Application (Agricultural, Horticultural and Forestry)
Landscape Checklist	Landscape Checklist
List of Conservation Easements in Fluvanna County	Conservation Easments List
Major Site Plan Development Final Checklist	Major Site Plan Development Final Checklist

Forms, Permits, and Applications

Pages