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APPLICATION for PRIMARY PLAT (or REPLAT)
Fee*: $1,150 plus $149 per lot (or$377 plus $149 per lot)
Office Use Only
DATE: DOCKET NO.
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 Carmel, Indiana- 1980", adopted under the authority of Acts of
1979, Public Law 178 Sec. 1, et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto.
Tom Lazzara 317-289-5990
Name of Applicant: Phone:
tom@customlivingusa.com
Email:
5335 Winthrop Ave, Indianapolis IN 46220
Address:
Tom Lazzara
Contact Person:
tom@customlivingusa.com 317-289-5990
Email: Phone:
Marissa Doner 317-289-5990
Eplan Review Contact Person: Phone:
marissa@customlivingusa.com
Email:
Tom Lazzara 317-289-5990
Owner: Phone:
Five-Ten Subdivision
Name of Subdivision:
510 1st Ave NW, Carmel IN 46032
Approximate Address/Location of Subdivision:
16-09-25-08-05-001.000,16-09-25-08-05-002.000, 16-09-25-08-01-010.000,16-09-25-08-01-010.000
Tax ID Parcel No(s):
Legal Description: (To be typewritten on separate sheet and attached)
1 .95 2 R-2/Residence
Area(in acres): Number of Lots: Zoning classification:
Length (in miles)of new streets to be dedicated to public use: 0
Surveyor certifying plat: Scott Bordenet
8902 Alibeck Ct., Indianapolis 46256 317-840-6532
Address: Phone:
sbordenet@civil-ls.com
Email: �/�
******************************** �****O, 1********************************
STATE OF INDIANA, COUNTY OF /UPI ' 1 , SS:
The undersigned having been duly sworn, upon oath says that the above information is true and correct as he or she is
informed and believes. .---------
Applicant Signature: 1r-rY.//lJ::lllJ',-./.,�Jflll./✓,,,i
1 YP" ryPua -; rye . = 1
O .. Vie.E;% Notary Public,State •
of Indiana
Print name: /ONv LAU e l 0` . g�1 Marion County
"'\ 0' °C.nmmiesion Number av0737554
�n Q i;=,.
� Commission
•••NGIAN�.�' MY ��
S n to before me this Y\day of filar Gl l , 20 1l , November21st2029
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My Commission Expires: `I ZI inci
0
Filename:Primary Plat 2021 Revised 3/3/2021 Page I