HomeMy WebLinkAbout06020012-Signed Demo
CARMEL UTILITIES
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01/13/2006 16:18 FAX 3177768506
01/13/2006 08:30 FAX 5458185
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HAM CO HEALTH OEPT
JORDAN
Demolition Permit Requirements
City of Carmel I Clay Town.hlp
BlIIIdb'la & Code Enfllrwm.nt/ Clly at Cannel
:In. Clvlesquare; carmo~ IN 480U 11ft. (317) 1571-2444 Jrax (317) li71-21W9
TO !IE SUBMrTTm.wln1 ~Pf..IC~T10ti..: Two cepll~lt of. elt. IOCllltJon mllp-ol..rly
IcfentJfylns the 8tructllAl br stnlcturea to b. d./TIolJ*hecl. the Tax Map parcel number for
the par~r on wh Ich the ~emQIItIOn Is to occur, and thl. form signed by the .pproprlate
dep.rtments. (".~plloetJon is . th~e.pllrt form a\lilJ/lble trDm the BuIldIng & Cod"
1!!nforeement OnlCW :
t:IQIIl
.
A l!IepBrate peimlt appllQallon must be completed ~er parcel.
Clrtaln Insped:lcns ere required relating to private wells. septic S}'lltemB, and fuel
tanks. prlorto!demoli1lon.
Shoul:! .ppro~rs be ~qufred from olt1er ste1e or ICC21 governmCilnt entllllll$. or
utllltla" (other than those addressed herein), It Is the lIole re!lponslbUIty of tile
con1Tilctor of "'CC1rd to obtaIn such Bpprovals,
Exf.tlnrz Wl/JII: Well mu~t be plugged lIccordrng to Wen Ordlnl1nce A-8,2. 1b"J.~~ I ~_~__~((
. 1'Iu.i'r,d "'1. ~-=A-'AJ,
eM"",, ..,fs 'optlc 1I)'IIWm mu.t bt pumped IUld 'filled with sand, Qr "'moved. tr uptlc
.system Is to be ....U.IId, It m.....t be plugged otr until re~Y for "'.!lJ... Ll . r
: ~rD/Je.r''-:1'''' .
Fuer Tanir!; I;:'uel tanl<li mu.t be pumped and rvrnovad f~rn bLlfldfn;- mdlClr propertrt.Fv~
.Js/5 Sa&.iv A.e~J, c....uJ..:r.A1 lI.rll~.OO'Oo-OO~' OOo6l'4r
Adllruu,"," . -,.,a: ,..".,. ~
COl~1M I 0 J",J.I..s.'r:J..~)~ i ) ,ogS ~. 13/,+ ~+ t'tt...w.41 'lid 1.l(b{J ~ J c'ii
l;:IWd-re_} Him. i1i1l4dCi_ . '
AtJrJltJonal SfrlIQtunl($) on ./",.: Y.. / ~ (If yes, plEl8se I/st the number end type(.) of
structure on the Iln8S Flr'QvldOd; Ifone of the strucltJrea hie lI11eparate street add/ll'8 than tne
pl'im.ry stNdur. on the ~el!--pleaae 11110 Include th;t infQrmatIon.)
.
.
-
Th. C/tjI of Carmel BI1:J/or Hamilton County HIIs!th Dspt mlJ$t plIform Bn fns~otlon prfor to
riamol/fJQn. In order to approve the dllmolltion permit, the IIppllosnt Is "qu/1ti41o II/gn thla foI'm .
11m/. O~f:l1n the ./an"l~ OfttJ:r~Jdul/a lh1tad lief""" (Thi. ClIII be done by FAX" IQ rh.ir .
ol1lan. ilt the numb.,.. "_led b OIM Inc/ude thlll -mp/eted fOrm wIth 1I/I.DDm~r1~t! .
BrOrllltUru (ON TH. JWV12R$E O~ THIS PAI'lS) when y&u 8UlNnlt your.ppl/Clltlorr Piloktlfl"
1. MaTTis HQII.'.~I BUP~r: WIINJo Trw~tment OP.,..t/ons City of ClJrmeJJ
"h"". ~17) 571.2tJ1J, I!IAX (317) 671.t2f1&, '
Bany Mdfulty: Hamilton CcIunty H8II1th Dept.;
Ph""e (!11) 171r-l600. FAX (311) 77U.fJB,
~ormIlI\Domchon _~1'Ill<U
2.
1an
CARMEL UTILITIES
JO~O^N
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01/13/2008 18:17 FAX 3177788508
01/13/200S 09:30 FAX 5458185 j
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I
HAM CO HEALTH DEPT
JORDAN
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Dato
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CI!RTIFICA TE OF AUTHORITY
,
I
Under the penalties of peQ'lIrt (India". Cod.. 315044-2-1), I h.,..tIy aMnn, under ollth, that .11 0' the
Infelmetlon I huye flrrlVlded In this application for dClmolltion perm" Ie tru. Ind ecollNte, to the
~..t et' my knowl.diie Illnd bIIlJef, end that I "aw /let kftowfngly or intentJonally provided or
omlttod allY Infgnnatlon that would tend to hide, oI310Ll19, or IlItherwlse mlslelld the Depqrtment
0' Community S.rvlcell I'Gg.~lna the tnIth of the matten; 8ddreaaed therein,
Fllrth.r, I_selt thlll I IUT1 tha properly owner, or the lIuthoNQd end l/lWfully IIppolnfllld 1188nt of
the ownl!1{s), that J ~ avo o:lq)",cs authDrltY and parml.slGn 'from the owner(.) (al1d anyone wlth a
Nc::ol'fltd I"bo....e or other Int&rellt In the property), to take ibis reqlleatad aotIon, Ind t1Wt I as I'll '"
to Indemnify and hold ham'll". the Oily 01 08""e/ trom any G'alm, lawsuit., demand, or dam.gu
whatsoever IIrfGlng (.tIt of, or.. II'8.ult of, thl$ Nq uut or the actlone gf the City 0' C.nnel,
regardlnljlllll1e,
D.te
~
(Name prl"ttd,
~J-SI(S.fl!'~
p/rcants Phone #.
~~W.I
AppHeant'1I Add'11IS$ :
.-.
7!J.JPIS
City,
.::tJJ
iT
'IG,J/f
~p
-
----
BTATI 01" INOlANA )
-,_ $8
Oounty II' _~.hIIWJo"" -.J
Befo!'e me, the undera'IIIUllf. . NotIry Public for --:J:...."n hI
"Ppearecr ::;hlol ..J,rJ 0,11
IMbument this --'"lo-.o Ilay at ! ~ '" ~...
County, State t:tf Indlllflll, p8~Qnally
and oICIkftOW"dged th. AXeout/on eftheforegolng
.20AL,
IlOWY~ 1.-.1
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