HomeMy WebLinkAbout 0083.00 Application6
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Township l
Application for
Permit No.
ate 1 m
(Print) (Phone Number)
Sewer Capacity Allotted Ian. G, 2000
Plan Commission/BZA Docket #:
L- 1.G--.)J
Reviewed/Apitovedi Dept. of Community Services
VX Improvement Location Permit Roll File
This permit isyAd only if construction is started within 120 days of issuance date; all construction must be completed (c/o issued) within 2 years of issuance,
date unless am extension of time has been officially granted by letter by the Director, Department of Community Services.
NAME
a
I PHONE FAX
Ft e E}A,% 6-fl, /A/C O `W %OOi
BUILDER
,
siXEer
m
cnv STATE ZIP
TENANT NAME
(if applicable)
NAME
PHONE FAX
Me
OWNER
sn EEr
crr LP
LOT SUaDM11ON l✓� LL�Ma_
LOCATION
ADDRESS OF CONSPRUMONN1�/���
^'J1�/ 9 '41Y/"LSYI'iI'
1 Z-(e!! •Y,. P.%!
/.'�I/ Y / / K�/�
A. TYPE O ONSTRUCTION
1. Family
Do plans luiie a porch 7
Well,
F. TYPE O_LJAWROV
Cr
I �,
2r Single
❑ No
I.
New Stiuc
2.
❑ Two Family
2.
❑ Addition
Room_=
3.
❑ Multi -Family
Type of Foundation
3.
❑ Remodel
0 a�3 en
4.
❑ Commercial I Industrial
OCrawlspace
4.
❑ Foundatio
— prjo II
5.
❑ Farm
❑Basement
5.
❑ Demoliti
6.
❑ OTHER
❑Slab
6.
❑ Accesso
. wvu 11�
(Specify)
7.
❑ S . oo
—�
B. SEWER- 8. ❑ Garage 1etached Attached
I. fYPublic (Name of System b G: Lot Split
2. ❑ Private (Septic Tank, etc.) H. Flood Zones YES _jN0
C. WATER: 1. Sump Pump YES NO
L GYPublic (Name of System /✓�% J. Manufactured Trusses YES NO
2. ❑ Private 1
D. ZONING: K. Plumbing Contractor 4—
—i'��'�D ' ✓
E. ESTIMATED COST OF CONSTRUCTION (Excluding Land Value) Z , oD Plumbing License #2A'?f 90Z15 �0`CA or ❑ CABO
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The undersigned agrees that any construction, reconstruction, enlargement, relocation, or alteration of structure, or any change in the use of land
or structures requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance
of Cannel Indiana - 1993" (Z-289) and amendments,; adopted under authority of I.C. 36-7 et seq, General Assembly of the State of Indiana, and all
Acts amendatory thereto._ I further certify that only kitchen, bath, laundry, andfloordrains areconnected to the sanitary sewer. I further certify
that the construction will not be used or cupied until a Certificate of. Occupancy has' been issued by the Department of Community
Services, Carme Indiana.
Inspections Needed:
C I ootin ', nderalab Rough- eter B
Site in C/O
if4$' 3
Permit (Square Footage) 341,00
.� Inspection Fees:
$4 00
Certificate of Occupancy: 15r00
TOTAL: 0&06
Fee Received� s\f w & m 121%