Pro Care 1979PAGE 1 of 2.
�Rev. TO-16 -72'
' ~ SIGN PERMIT -APPLICATION
I
(To be filed.in Duplicate)
Date:
ld Permit No.:
(This form -combines the Improvement Location Permit Application and the Building Permit)
(Application.
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 Cae12 Indianasembly of 1961".the adoptete oflnunder the authority
of Chapter 174 of the Acts of 1947,General
all
Acts amandatory thereto.
1. NAME OF BUSINESS AND LOCATION ON WHICH SIGN IS TO BE LOCATED:
��b Address:
Name: CA
Township* 1H Legal Description: Lot No. - SeE ��hCfEi f% r
addition. (attach metes & bounds description)
2. LAND USE CONTROLS APPLICABLE TO REAL ESTATE ON WHICH SIGN IS TO BE LOCATED:
Zoning:.
lj _ Variance required: yes, no
Pertinent variance conditions or parol covenants:
3. APPLICANT: h 8�G-9'l 03
Name: �'\OR i Pot-Sl�'Y , Phone No.�-
Address: 8,27 C4�nu A2
Owner of Real Estate on which Sign is to be located:
Name: K/10iR-1 Address: 4�{4 }J�cJtlC�JSTyi �uJ
Phone No. 64.6 +B 0 S
Contractor Erecting Sign:
Name of Firm: ?(LJ C-Alze , Address: 9g �Eir� �UC{GSjF} Pi
Phone No. ^ [ 6 4 30�
4. SIGN INFORMATION: /
.Type of Sign: Advertising Business ✓ Incidental
Ground Projecting Poler
Placement: ,
Roof Wall
Lighting:
Incandescent Florescent c LJ F--
Dimensions: Single -faced Double-faced
Vertical 7 £t. Horizontal ft. Sq. Ft. of Face
Y r
Height Above Grade: I
Number of Existing Signs on Property: Ground O Roof O Pole O Projecting 2
LOCATION: 1 t
Wall C?
feet from Right-of-way line.
5, ADDITIONAL SIGN PERMIT REQUIREMENTS:'_
All applications for the combined sign permit shall be accompanied by the following
items:
A. ,Two copies of a Plot Plan drawn to scale, which shall include: !"
1. Location and dimensions of the affected lot: 11
2. Location of the right-of-way line or lines of adjoining highways, streets,
alleys, and easements.
3. Existing structures and signs with corresponding size and setbacks.
1�. Exact location of sign structure on lot with setbacks from all property
lines.and street rights -of -way.
5. Information showing location of any signs and residential structures on
adjoining lots and their distance from the proposed sign.
B. Two copies of detailed structural plans showing an elevation of the proposed sign
with height, width, and depth dimensions, along with mechanical and electrical
specifications of the proposed sign.
6. CERTIFICATION:
I CERTIFY THAT THIS SIGN WILL BE ERECTED AND MAINTAINED IN ACCORDA74CE WITH:
1, the statements made on this document and plans filed with application for permits;
2. zoning ordinances of Carmel, Clay Township, Hamilton County.
Contractor's Signature
/ (or attach affidavit of
Estimated date of Completion:
FEES:
Improvement Location Permit a
Sign Structure Permit $
Total Fee $
Permit Fee Received by
,Title
SP-1 Oct, 1972
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Pmmbed by State Bo.d Of A=—U
-� CITY OF CARMEL
RECEIPT
BUILDING COMMISSIONERS OFFICE
iCL� - sw - FUND
CARMEL, IND.,.-
RECEIVED FROM
THE SUM OF
ON ACCOUNT OF
C.6 COTCC CO- MOM"g. "'I. GENERAL FORM NO. 352
N° 11773
SECREi Y 0 BUILDING COMMISSIONER