HomeMy WebLinkAboutApplications
Rev. 1-1-61 Sheet 1 of 2 Sheets
ZA Fcrm (To Be Filed in -Duplicate) rate
PC Form _
APPLICATION FOR IMPROMME3T LOCATION PEMiIT AND CERTIFICATE
OF OCCUPANCY
No* i
Date Filed;;&
f �c
The undersigned agrees that ny construction, reconstruction,
enlargement, relocation or alteration of etructurc, or any chenae
In the use of land or structures requested by this appliontinn will
comply with, and conform to, all applicable laws of the Stnte of
Indiana., anbj, it� n �r1}q� el, Ind Inns. 9 9
adopted under' i o r oi' �IYa i r 4 of the �lct io - X14
4encrnl AeeoJ�rcof ihE me of Indinnr, and all note amendatory
thereto.
Nnne of dpplisnnt '_pons No. 9 2 ` 79 6
Address of .applicant
Name of Owner L,� c.. one No.
Address of Owner
Locntion of Property: Lot ado -.: 47- in__ _l2/ac —T 1, Addition
Street No. or other description of loont ion7- s sr 1¢�!
kd"
Present Use of Property 1,97-
Proposed Use of Property_Osins.,�
Zoning Clpesiflcrtion of Property p_1
NOTE: Application for rn Improvement Location Permit must be
accomprnied by two blueprints of r plot plrn of the property
drawn to eor.lc, showinZ lot liner, dimensions, easements,
utilities, etrcct widths, and showing loci tion of nny exist-
1;e/4-104i
�� ,i S atruct r or proposed structures together with r detntled
��c a of the proposed Improvement, and other
or t"' on ..._ m: M. Va uircd. _
SIGNEn s! �!� / j �l .10
-
(Owner)
6 Agent
A Permit Fee of must accompany this applicati
Permit fee received by_L�.
Title
IONER
C Li:, Y T0VVNS-11P '/Go In1049o,4PA-1V Sj�.eS-
HADdILTON COUNTY