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Swimming Pool/Spa
Permit Application
City of Carmel/Clay Township
Permit No.:
=It 0 100 ~ooo7
Name
Phone
Fax
BUIWER: e Haven Poo I:, 311 - J.(:H-I ~oo 11 - J..(A-I SDO
P.O. Box / Address City State Zip
. CD u n-tr C I u b J<d.
Name Phone Fax
OWNER: v6h GQ('ci ~ 311- I-I
Street Address City State Zip
1 ~3<i? 1...; nnuJOo Blvd Cav-meJ :rt0 lflo 0 33
LOINo. Subdivision 'Plum Creek. Section Zoning
Construction L t"WOO~
Location: Address of Construction Q:rme.1 State Zip
1~3~ L n t) WOOd Blvd .ThJ ~Io 0 33
E...timated Cost of COll.<;ouction: (Pool & Deck): $ 5~ SqlL1...e Feet (Pool & Oeel;): I 3c;()
Pool Healed: Y/N
1-100<1 Zone: Y/N
Auto Filter: Y/N
For Omnnercial Pools, stu:e
Class of pool being built:
I
J
Conunen.-ial Pool" - provide
Stlte DeSWl Rdea....e No.:
I
Oll SIte P ill
l
Safety features (including pool cove omply India wimming Pool Codes 675 lAC 10-4-27 "Safety Features". Egress systems
that involve steps with three or more" 5., uire a h rail instaUed to specifications ofthe ~~IUI Pool Code.
The undmigned agrees thai: any construction, r slruction. argement, reJocatiOIUJ-.lt~~JilUCI~~&e in lhe use ofland or struct:tm=s requested
by this application, will oomply with and confonn 0, all a ,c: I@~VJ,,~WatF~~qr~~~ 2().I.I-l through 20--U~22 and 675 lAC
10-4-1 throui;jffjQg12()....4..2.7;fofoon . .675 O-11~'thron~':!b1-9).,a~.~. .. It)~j~j.!~el,1.ndiana-1980,adoptedundectheauthorityof
CON ' ., GeneralAss~hfl\""1!1< sate.~\hlt'uma. and aJrl\ln\a~ ~\1-.S
..( ~o " <''-'Ie ano 1::. ,.. V\v~
I . access 10 property thlv'uth.'''' .' . 1i)k L~/ished driveway. the applicant
must gain approvals through the City o/Carmel ~Fi"8ll:JeJn'. . i4f~ . y Higlrway Dept. (773-7770).
(Whichever is appifcable.) CIT'f Of C ;';"""a.NA.
I hereby celtil}. th.-u the improvement IswimminK roo1 ""ill not be used\\~i;d - until a CertifICate of Occupancy h.u heen issued by
the Dep."Utment of Conullunity Services, Cannel, Indiana.
6 v-J I (I..-
eo ".J(.J<"
llillJ-il kJ
.Signature of Owner o~Aw.nt
~~_~D9..:J'-fOO
(print) D (Phone No.)
BZA Approval: Y/N
Penuit Fee:
Inspection .rees:
Date:
Cert. Of Occupancy: S- / ~--o
mr~. ~.~~
L7/ - ' ~/
~",R " .:
{/ .
BZA Docket No.:
C, -.r&.:, 'J H/s eN (J - h - 0 2-
Re\ie\'n~:d J Apprnv d By: DepL 01 Commumty Semces
S:PennitslFonns/PoolslPooJ Application Rev. Jan 2004 (WEB)