HomeMy WebLinkAbout06060068 Signed Demo
X 3177768506
06/07/2006 1~U:OU~ ~~'49AM REMAX CARMEL
JUN. I., v 1M';'" 1I17S'I~:':""':l
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Demolition Permit Requlreme"ts
City of Carmel, e1n Town.hip .
EUdrng & Oede .2nfollllsml!lll; Oily 01 09rmer
One Civic SqlJllnlj C8rmel, IN 46032 Ph. (317) 571-2.444 Fax (3H) !7'1-24rie
Su n eo lea of alte location mill le8I1y
. Jdentlfylng the Sfructu/'ll or Gtructu.... to b8 demo'laheri, the ax .p p~ number far
... - on ""....... -..... Ie "'__. ....1Ns "'nn.rg..., by..._.....
departrnentll, rAppll~tJon ill a thl"8&-tMtt fonn av.llable from ttJe Building &. Code
Enforcement 0",") . .
NOte;:
· A 8eparate permit 6lPplioatlon must be completed per parcel.
· Certain inspectlons are required relating to Private wells, '8pt1c system., llrid fuel
tanka, Pi10r to ~.molltlon. '.'
. ShOUld approvals be requll9d from other State or local governrn9l'lt entities, Or
. utIIftfes (other than those addNl8sed herein), It Is !he sole I'8Sl)ons/billfy of the
contractor of record .to oblain lluel1l1pprgvals. .
. kist/no INBm Weir must b, plugged 8caordlng to Well Ordlnalttce 482.
lM,tJnG Ben~ hPtlc S)'8tam must be pumped and "lied with slInd, or remaved. rt septic
IYlJtem I. to b, reused, It must be p1ugggd oft until "'*'y for rA.UGe.
BJe/jIm/rJ!.;. . Fllal tanks must be pumped and RlmOWd fhln1 bUlldrng and/or PrDperty.
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HAM CO HEALTH OEPT
CARMa UTIL.ITIES
III 004/005
NO. 7662-P. 4
PAG:: e3/B4
Z31 \I ~ 8tt.~t. ClI:tmel. nr 4603:.1 1609251SDlOO7000
AlfIrNi4j af<fMIolHJarl - Tcr '*p "-fCelfI.
Cct!ll.;l D.....lopm..nt. Ltc.. 200 KlId1,,1Il ~J:, Sll.f.t.. A., Carma1, IN 4603.2
0wrI8Ife) Nlilllea,lCf d,.1I5 V..fY~ .
Addltionsl StrrIctlife(.) "" sf, I (~, please Jl8t tI1ll number and ~S) or
lltrvC't!Jre on tfle lines Provided. ADS has a separate street address than the
Primary structure on the ~ase IIISCllnolUde that lnfolTn8tlon.)
~r:>,.J. t:7,,~ .
,. The 011}- Of Cafm$/ end/or HSmllton Ooun~ Health Dept. muet pe'rform en ~ f)/1rJr fD .
:a. d.fiIrnolHlon../n order CO IlPPIOIhJ the demolition fJetmit, the 8pp/'/WI1t Is Nquir8d to sign ~ tbrm
and ~"fn me MtmQ~ras (JIM. /lHilvlduals I~fed be/Q"t. (this Cln be don. by FAX to their
omoat, at the nUI1JbMlI/$ted below) InolWe tilTs ~~tud "'"" with all aDDJaDI'bI1!
$lanlfutet (ON THE REVERSE OF THIS PAGE) when ,lmu SUbmit your ~Ppnctlt/on packll{le.
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1. Morris Ifenshly, SIIpwv/sOI': Wa_ TlWtment Op~tIons. CIty of Carmel;
Phone (317) ~1.2(j73. FAX (317) S71-D'!8. .
2. a.fry McNulty: Hlmllt10n CtJunty Hq/th Dapt;
PhQIHI (317) 778-8500. FAX (317) 77~.
s,~"" IlIOmlI1oftbJl
1<112
06/07/2006 11 :05 FAX 3177768506
JUN 7, 2006 10: 49AM REMAX CARMEL
8S/0512886 14: 19 J17571:l2S3
HAM CO HEALTH DEPT
CMMEI... UTIL.ITIES
~ 005/005
NO, 7662 ~ ~4/B4
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Slgn.IU,.: Morris He....., Car "-"ntafM)
Data
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,9~ fI'^~~
SJgllllttll1l; Ba M fty Cur n1pruenta..) Date
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Unde, the P8naIUes fit PllIlfury (Indiana Cod, 35-<r~ 2-1), , hereby affirm. under oath, that ai, tlffh.
I~ I haw Itrail'ided in !hie appllcdon for dernolltlcn p&rmJt Is fnIe .nd l!CCum6l, to the
best of my knowIDdp .nd belJef'. and fIlat I have not knowingly or Inf8ntlOI'l8IIy provIdecI or ,
omitted .ny Infonnatlon th8t WOUld t8nd to hide, ObsoUN, or otherwise mtaJeacl the Department
of Convnun~ SenlJcea r.&llrdlltg the truth of the ;nau.rs liIdcfreelmd fIIe,.'n. " .
Further, '....rt that I am the praperf:v owner, orlhe autf\.A ~ BrId h1Wfully llppo'nted agent of
... awnel(8). that I haw QlCptus authorfty and pelftllaalon ftoam the 0lMner(.) (and anyonelltilh a
,reCOrrJed Inferest or IItIler Inte~4n the praperty), to take this reqlle8tad action, and IhM lag..
to 'ndemnlfy IlIld hold h8tm'ess the City gf Carmel frmn any dalm, r.weult, ~ or damages
whats08ll8r IIIfslng out of, 01' as a _lilt of, fIIJe NqlHlOt or the ecaORll 01' Ihe ~Jty of Cannel.
NgardfnS lIIiUIIe.
CERTIFICATE OF AUTHORITY
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