HomeMy WebLinkAbout06060068 Signed Demo
06/07/2006 11: 04 FAX 3177768506
JUN. /.lUU6 10:49AM REMAX CARMEL
B6/05/2006 14:19 3175712265
, ( ,. · .. Dt:tinofltloo Permit Requirements: .
City 0.' 'Cumel/. Clay' Township
Buldmg /I cOde !hrorcll~ CI\)I i;rf 0llJrn&l .
. One OMg Squal'll; 0IIm1!, l~ 48012 Ph. 13m 571444.4 FISl( @17) ~1-249ll
~: Twe' copies of l eits'ocatlon map-c'aarly
Identify/nil he strueturv or 8tructu"'8 to be demon.heeI, the To: Map parae, number fer
the parcel on which the cf.mgUt~~n II 10 occur, llIId thJ~ fann"'gned by tile approprfate
department&. (*Applm.t1on /$ 8 th,..part farm 'Vlllabl. tram tile auJ/dlng & Code
Enforcement Offf.ce)
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HAM CO HEALTH DEPT
CARMEL UTILITIES
~ 002/005
NO. 7662 P. 2
PAGE '811M
· A seP8l'l18 pennlt applIcation muat be COmpleted per parcel.
Certain ~ns 1(8 required relating to prfl.'atQ w.nG, septic ~tems, and fuel
lanb, prior IDdemolftlOrl.
Should lIPprovaJl!l be requfl'ed from other St&t8 or ICcBllJ,OVImment tntItIss. or .
Ufllltlea (other ltIl!ln those adtf~ herein), It is th& BO'9l'8!IpOns'~"ly of the _ _
contrl!oIDr of.record to oi)taln such approvals.
6JdMlna WIll!; . WolI must b' plugged lIC!CCJJ:dlng to Well OrdInance A.e2. .
" ,
ExfIdIItfI -~Q{ Septic '8Y8tem must b. pumptd Irld fined with sand, or: ~VlId" If septla '
. . s~ Is to ~ ,.u.ed, It m". be plugged ofhrntlJ ntmyfor re-uee.
FuaI TlIIJ@l FI{$I tanlal mUlt be pumpod _"d "'moved from b"rldlhg'.,,~or property,
221 Ii' HAin stieec:. ca~i, Iii 46032 J6092S160100POQO. '...:',;
AddrB8 otfff1molttlon 71rdll,lt ~'" . " '.
. I \1. .
ZOO )(ecl1.cal Dr, S\&1;'4l A. Came~, IN 46032' .~.
.
.
'.
tlul nave t. IJ,C,
nll'(-> Name Ulel Adcl_ . .
A_~ ... ~:)I(o '. ("i"O, P....lIol1l1en.....;~ ""'<'l.ot
stnlcIul'll on the ""AS pttlv!ded. the a1rUcIures h88 &\ Bep.lltlite street acIche8 than the '
prfl,na,ry structure on 1f1e PIII'OIl-p16E188 aI80 Include that Infol'lTl8fJon.)
I Acv. ~\ d 1\ . '. '
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06/07/2006 11.05 FAX 3177768506
JUN. /, ~UUb lU:49AM ,R~~AX CARMEL
~O/~'~DOb l~;~~ 3175(l~~b~
I
'.
CARMEL. u:rIL.ITIES
III 003/005
NO. 7662 P. 3
PAa:: 1l2/!l4
" 'O' "'"
HAM CO HEALTH OEPT
~
: MonfS 'Hen.'ey (or rep~. .
I~ '--6-lb~
Oat&
.~~~ "I"(.~
CERTIFICATE OF AUTHORIty
Under the penalties of II8I1II1Y (IndbuUI Code" 3S~-1), I h....by amnn. under od, fha'.II of the
Informlltlon I hllV8 Prolllcled In thIt apPlII:atfon for tamolltlon penn" Is true IUld accurate, to the
best of my knawrecfge _lid bolle', anCl.ffrllC I haw noc knoWIngly or Infanlll)ftBfIY.Pf'O'I/dec/ I1r
omlnad 80y Information thlllt wollld tend to hide, oblJGURl, Of otMl'Wfse mlsl88d the Department
ofCommul1/ty Senlfous I'8garc/Ing'th. trufh oftha matt.15 addreea.d thereIn.
. ,,, '1
Furth.,., I usMt'th8ti';m"ti,a Phlp81ty lWIn";; orth. allthortmd'lIl'I~ 'iiwfUJiyappo'nwdagentOt
the awn'r(s), thBt I haw ~a iluthorlRy lInd pennl,,'on from the owner(8) (DlJd anyone with a
' rellOl'dod Inter.st or other Intarat'" ~. propelty). to tab fhr. requested l!lOIon, and that lag,...
, to !ncl<<nnllY and hold hannle88 the City of ~., from lIny Glalm, '--uif, dalnand. Or damages
Wha1sCl~r llII9lng out of, or. a rilsUJt of, thll raqueet or the actIOfIIl of fII. CIty of Cannel,
rugwng Arne.
,,\~lDb
Dats
(~rne prfnted)
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ApPIlcant't1 Acfu....
~r
~4.0-'
City,
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Appncanta Phone #
~6?}3~Z
ZIp
-:Vv
51
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