HomeMy WebLinkAbout030043-Signed Demo01/08/03 11:41 FAX .317 778 8506 HAI/ILTON CO. HEALTH DEPT 001
Q DEMOLITION P RMIT R QUIR M NT$
To be submitted w th appl cation*; Two co les f
.... ; . ; . - ; p o a s te location map, cleady dent~fylng the structure
s~ruo~ures To I~e oemoi sner~ and m s form s gned by the appropriate departments. (*Application is a
three part form available from Permit Services.)
Certain inspections are required relating to pdvate wells, septic systems and fuel tanks, prior to
demolition.
Well must be plugged ac=oral/rig to Well Ordinance A-62.
Septic system must be pumped and filled with san'd, or removed. If Septic
system Is to be reused, it must be plugged off until ready for re-use.
Fuel Tanks:. Fuel tanks must be pumped and rsmoved from building and/or property.
Addre~ of demoli~on; ~
The City of Carmel and/or Hamilton County Hea#h DepL must perform an inspection prfor to demo//tior,.
In Orderto approve the demolition permit, applicant I~ required to sign this form and FAX to the
Includ~ this ~co~pleted form with ali appropriate signatures when you
submit your application package.
Morris Hensley, Supervisor: Water Treatment OperaEons; Cl~y of Carmel; (317) 571-2E54.
Barry McNulty; Hamilton County Health Dep[; (317) 776,8506.
Applicant's Signature Date
or
Under the penalt~ea of pedu~ (Indiana Code 3S-44-2-1), I hereby affirm under oa~ ~at ~1 of the ]nfo~ation I have ~ro~[ded In this
application far demolltlea P~lt Is ~ ~d a~ to the best of my ~ledge ~d belief, ~nd lhat I have nat ~owin~y or
Intentionally provided or cruised any J~for~on ~at would tend to hrde~ obs~am or othe~lse m s cad the Depa~ment of
Community Sewices regarding ~e t~ of ~e ma~em addr~d therein.
Permit 3e~/ces.. One C/viG Squam; Carmel, IN 46032 Ph, (317) ~7f-2~4 Fax (317) 571-2499
Signature & Date; Morns Hensley (or representative)
/VOTE.' Should approvals b~ mquimd f/~m other ~ate oriole/governmen~ enEties, or utilities (other
than those a dd~$~ed herein), it ~s the sole ~spon~ibility of the ~ntmctor of record to obtain such
approvals.
City Of Caramel
DEMOLITION PERMIT REQUIREMENTS
To be submitted with application~: Two copies ora site Iocatbn map, cieady ident~ng the structure or
strUctures to be demolished, and this form signed by the appropriate departments. (*Application is e
three pa~t form available fn~m Permit Services.)
Certain inspectinns are required rela[ing to private wells, septic systems and fuel tanks, prier to
demolition,
Well must be plugged a~co~ding to Well Ordinance A-62, ~J~
Septic system must be pumped and filled with sand, or removed. If septic
sys[em Is to be reused, it must be plugged off until ready for re-use,
Fuel Tanks: Fuel tanks must be pumped and removed from building and/or pmper{y.
Address of demo(' 'on:. _
The City of Carmel and/or Hamilton County Health DepL must perform a~ inspection prior to demolition.
in o..r~,er to approve the demolition permit, applicator is t~equired to sign this form and FAX to thee
~ Illclude this completed form with all appropriate signatures when you
submit your application package'
't, Morris Hensley, Supervisor: Water Treatment ?~era~ons, City of Carmel; (3'17) 571.2654.
2. Barry McNuI~: Ha'mii~on County Health Dept.; (3¢?) 776.8506.
Applicant's Signature Date
Applicant's Telephone Number
Signature & Date: Barry McNuity (or representative)
NOTE: Should approval~ be required [rom other State or tocal governmen¢ en~ities, or ubTities (other
than thc~se addrea~ed he~), it is ~e sole ms¢n~bil~ of ~e ~n¢~ctor of mce~ fo obtain such
app~ls.
Un~ t~ ~nafi~ ~ p~ ~di~a C~e 35~2-t), I he~y ~ffi~ u~r o~ ~at ~1 of ?e ~p~on I h~ pm?d~ l~ this
~plio~ion ~r ~m~oa p~ ~ ~ ~ a~um~ ~e ~ of my ~o~dge ~d ~f, ~ mat t na~ n~ ~owmgiy o
]ntenfi~ly pmvl~e~ Or ~ anyl~o~a~ ~at wou~ ~nd to ~, o~oum or othe~e m~ad the ~p~ment of
P~ Se~ces: One CMo Squam; Car~t. ~N 4~2 P& (317) 57~-2~4 Fa~ (317) 57~.2499
S:Pem~s'~De,mdi~ion pem~it har~3u[