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?A. Form (To be Filed in aiplicnte) ?;._ate
PC Form
APPLICA.TTON FOR I1,,PROVF1%,-\'P LOCATIO: PER ';TT .\D CEP71FICATE OF
0CC13PA i� C
No. _/3 a_-6 9
Date filed /7LC- `L3-194 s'
The undersigned agrees that any construction, reconstruction, en-
larfiement, relocation or alteration of structure, or any change in the
r se of land or structures requested by this application will comply with,
-:nd conform to, all applicable laws of the State of Indiana, and the
"Zoninrr Ordinance of Carmel, Indiana -1961,11 adopted under the authority
of Chapter 174 of the Acts of 1947, General Assembly of the State of
Indiana, and all Acts amendatory thereto.
Name of Applicant�Phone No. 2 J-3 -
Address of Applicant �9 34- 4-- 6 _t T
4 z z u
Name of Owner Phone No.
Address of Owner
Location of Property. Lot No. _ Addition [-�)�� r? s T.
:street No. Pr other description of location
rresent use or eroperuy 1--e; 7
Proposed Use of Property 2
Zoning Classification of Property
NOTE: Application for an Improvement Location Permit must be Accompanied by
two blueprints of a plot plan of the property drawn to scale, and showing
location of any existing structures or proposed structures together with
detailed written explanation of the proposed Improvements, and other in-
formation as may be required.
SIGNED:
Owner Agent
G
A Permit Fee of must accompany this application.
Permit Fee received by !Z%_" ���
rMILDING, COMMISSIONER
Title
APP
BUILDI ' C COMMISSIONER
CLAY TOWNSHIP
HADdILTON COUNTY