Sample Club

Modification Request Form

A Design Standards Community

Date:_____________________

Name:_____________________________________
(Please Print)

Address:___________________________________

Phone:____________________

Modification(s) Requested
(__)A. Fences (Specify materials, style & sketch on plat)
(__)B. Landscaping (Specify & Sketch)
(__)C. Pools & Spas (Plans-2 Sets)
(__)D. Recreation Equipment (Kind & Location)
(__)E. Repainting (Paint Mfg & Color)
(__)F. Roof (MFG, type & color)
(__)G. Screening (Specify mat, style, & include elevations)
(__)H. Structure Addition (Plans- 2 sets)
(__)I. Structure Modification (Plans- 2 sets)
(__)J. Tree Removal (Sketch)
(__)K. Other (Appropriate Description)

Modification(s) Description
Attach additional information if necessary

Form Return Address:

Township Residential
3131 Piedmont Road Suite 100
Atlanta GA 30305
Fax: 404.233.4625 Telephone: 404.233-1551

Architectural Control Committee Action

Date Received:________________________
(__) In person
(__) Faxed
(__) Mail

Date Reviewed:________________________

ACC Reviewers(s):________________________________

Date Responded:______________________(within 30 days of receipt)

(__) Approved
(__) Conditional Approval *
(__) Disapproved *

* Requires Explanation