Pioneer Heights Section Two

Property Owners Association, Inc.

PO Box 1681

Winchester, VA 22604

Architectural Review Committee

Property Change Request Form

(for changes to Lot and/or Dwelling)

DATE: _______________

NAME: ___________________________________________

ADDRESS: _______________________________________

_______________________________________

PHONE: _____________ E MAIL: ____________________

PROPERTY CHANGE REQUEST: (attach sketch or drawings for clarification) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Date Received by Committee: ______________ Date Reviewed: __________________

Date of Response: ________________ Reviewed by: ___________________________

Comments / Signature: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________