Form C-411(V) SURVEY OF RESIDENTIAL BUILDING OR ZONING PERMIT SYSTEMS

Attachment A
C-411(V)

FORM

OMB No. 0607-0350: Approval Expires / /
U.S. DEPARTMENT OF COMMERCE

SURVEY OF RESIDENTIAL BUILDING
OR ZONING PERMIT SYSTEMS - VERIFICATION

Economics and Statistics Administration

U.S. CENSUS BUREAU

Person Completing
This Survey
Name
Title
Telephone
Fax
E-mail address
Internet web address

Section 1 – Permit System
A. The following narrative describes our record of the geographic area(s) for which your permit office is
responsible. If no narrative is present, continue with Section 1.B.

Is this coverage correct?

Yes. Please return this form now by choosing a method described on the reverse side.
No. Please continue starting with Section 1.B.

B. Did your permit system have a geographic coverage change?
Yes. Mark an (X) in the appropriate box(es) and enter the requested information.

No

Permits are no longer required to build new residential buildings:
Effective Date

Permit office has merged with another permit jurisdiction:

Effective Date

Name of permit jurisdiction with which your office has merged

Permit office has split into two or more jurisdictions:

Effective Date

Name of additional jurisdiction now issuing permit(s)

Name of additional jurisdiction now issuing permit(s)

Name of additional jurisdiction now issuing permit(s)

Extraterritorial jurisdiction (ETJ)/Annexation:

Effective Date

ETJ in miles or define annexation

If more space is needed, please continue in Section 3
( - -2011)

Skip to
Section 2,
Geographic
Coverage

Section 2 – Geographic Coverage
A. If no narrative is present in Section 1.A., please list the geographic area(s) covered by your office.
If a narrative is present in Section 1.A, please review it and add any geographic area(s) covered by your office
which was omitted.
Type of Geographic Area:
Geographic Area Name

County City

Town Village Township Borough Other - Describe

B. Please review the narrative in Section 1.A. (if any) and list all area(s) NO LONGER covered by your office:

Section 3 – Comments/Additional Information

Mail to: U.S. Census Bureau
Manufacturing and Construction Division
Residential Construction Branch
Washington, DC 20233–6900
or
Fax to: (301) 763–8587
FORM C-411 ( - -2011)