Northern Heights Homeowners Association

Request form for Architectural Review Committee

Mail to:  Northern Heights HOA, P.O. Box 291, Lititz, PA  17543

Date of Request _________________________ (Please allow 60 days for reply from NHHOA)

Property Owner _________________________________________________________

Tenant name (if applicable) _______________________________________________

(If tenant is making the request, property owner and tenant must sign request)

Property Address ________________________________________________________

Please describe the requested improvement __________________________________

Is your request currently restricted by the Restrictive Covenants? _______

Have you submitted for Township approval, if required? ____Date submitted _____

Include the following with your request if applicable:

_____              Plot plan showing current location of dwelling and intended improvement indicating proximity to lot lines

_____              Building material samples (brochures are acceptable)

_____              Color samples

_____              Copy of the building permit from East Manchester Twp. (if applicable)

Conditional approval may be given prior to obtaining permit; however, final approval is contingent upon receiving copy of permit.)

________________________________________________________________________

Requested by (signature)                                                                                          Date

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Date reviewed by Architectural Review Committee ______________________________

Approved _______      Denied ______

Board Member Signature __________________________________________________

Comments ______________________________________________________________