HomeMy WebLinkAboutApplicationRev1-1-61 ^'c, ]c)t 1 ;,f 2 ..eo s
ZA Form (To ail
e FU -6 in Duplio,-tc) Dac :
PC Form -/ _;
APPLICATION FOR IiIFROIT` + TT LGCjj`f_0j' C : _P AND 072TT_-'WATE
OF GCCJ:e_l i ci
No. 1.30`4
Date Filed, &-z /i - G •/
The undersigned aareco that ny conrltruction, reconstruction?
_enlargement, relocation or ^leer^t or. of etructur•,, or any chengq
in the use of land or structcire= cu ,rated ')c thic application will
comply with,and confon:- to, call lcwe of the Stnto of
Indiana, and the "Zonin; Ord r.•c:_^,e of J"r^.'_, indicna -- 1959
adopt _d und-r the authority of c -:E 1. 4 aJ' the Lctc of 19fo-7,
General l,seclably of the Stotc• of Indi^.nr; rrld all note nm.ndn.tory
thereto.
Name of f A'ucnnt,�
.9ddretic oof .a�plicnnt
Name of Owner
Address of Ow r l Z L
Location of Property: ,Lot '
Strcct,_l?o. or other dceeri,".,
Pio .61 J - jj
__ hones c No,
Present Use of Property_
Proposed Ucc of Prop:�rty._J• _
Zoning Class ific.^tion of Pro :ort; __ - aL_
NOTE: Zpplic^tion for ril T_nrrov--m:=nt Location Permit must be
neoorlprnied by t,;o !luci-of r plot 1)1!-n of the property
drawn to sc^lc, _-ilowinZ lo'.: li_—, d*Lr::cneions, creomcnto,
utilitic^, ctrcct ;,i fth : n:' chorda- loci tion of nny exit-
ing structur c or Drcpoa cG ;:tructur_r to;�cthcr• with n dctciled
written cxplpnrtion of ti:c proporcd Improvement, and other
inform^tion ^R m -y b.--r*quircd.
SIGIQED:
O ,ncr .
vu
b Pcrmit Fcc of v hurt cccoi_,1).^.ny this 1ication.
Permit fee received by � :,c��. %f. cti�1C, .
(Title)
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