HomeMy WebLinkAbout06070184 Signed Demo
FAX NO,
PAGE 02/03
NO.19~ P.1/~
P. 03
04/01/~?0p.",RJ~ 19 ",,,~~7571j~iAIi=I FARME:RS
HAR-28-200B IoIED 11 :26 AN
CARMEL UTILITIES
. ,
Demolition Permit Requirements
City of Cumell Clay TownshIp
a~lld/!ls B. Cllde, ErlfDl'C9menl: City 01 ~rmel
ene Civic Square: Carm!I, IN 40032 Ph. (317) 571-2444 Fax (317l671~
"'-'
TO SE SUBMIT!ED 1(i1J1-l ~'CA TION*: Two COpies of a sIte ItJCJtion map...cJlI8rly
identifying t/'jg utruetlJl'Ct or ~cturG$ to J;te demoliShed, the Tall: Map parcel nLlmber1ar
the pal'C81 on Whlllh the dlunolition is to occur, and thIs fonn signed by thlllotppropriafe
departments. rApplicatJon Is III thrse-part form allallable from the Building & Corie
Enforcement Oflicte)
lSOTE:
*
A separate pemlil application must he completed per par09l.
Certain inspeclions are requrred relating to pril/ate wells, septic s~ms. and f4el
tankg.J~rforto demolition. ~_ /1.PjCfJ~ ft. /.f;.e:.P'i le.q
Shoufd approVlills be requrred m other State or 'olOal governmem en1ijjss.-br
utilltlea (other than thosli addressed herein), It is the sole responslbmly at'tl1e
contracfor of record to obtain such approvals.
&is:finaW8n: Well must be pluggccl according to Well Ordlnl!lnce A-62,_ CJ }..J e ~e r L
/!:J({stfnq seDfic: e;eptic system must be PUlnpecl and filled with sand, or removed. If liIoptlc I \
ll~em is tQ be rewed; It must bit plugged off until ready for ~.,;,;;e.:z Sep ) c...
, ' Fuel ianksl Fuel tanks ~st be WPlld ane! remowd from building andlol' I'l'aflIIrly,
''-<;) /~ (jJ. Smoker;."(;ipW '!sf:L
~-"O'~'Y"rr () 'J../ II l/ ~f'apPa1'ClJ/#
lJlfHJE. L. ',,:~rn(n7-IoIS E. ~/tj. Sf - r2Y7tEldll/J.7J.I t/kt9
OwrnIr('l Name Mil Add.OKS ,
*
.
Adr:tltlonal SfruCfurs(.) on site: Yes I No (If yes, please list the numbar and typil(S) of
structure on the lines Provldacl. If one of tl1e struCl'lJres has a separate streetaddress than the
primal)' structure Cf1 Itle p,srce sa also Include that Inform ion.)
cR.}':!:.... W, Sm.o - OCU M 6 /
:::::
-
The City of CemlelancVof Hamilton Count)! Hsa/fh Dept must perform an im;pectJon prlarto
demolftJon. ~f1 ordsr to ilPProve the demolition permit, tile llpplicant /$ requil'ed to !lifPI'thlB form
and pbfr,;1l thfl SlqnBG'l/'.fJ,S of the indlvldu..lt: lirtrNJ below. (TIII$ elln be don9 by FAX to thrJlr
offices. at tile nUl7lblO/"$lIstfld below) Include th4s GCJmpleted form ytlth /J111J'1PfDDl'iate .
Slfm.du~ (ON THE F.~EVERSE C:>F THIS PA GE) whe~ you submit ygur appliCfltlon paeka(/9.
of. Marris Hensley. SUpetVltrQr, Water Treatment Operatfons, City of Oarm;!;
~-..' Phone (311) 511'-2873. FAX (317) 571-22~5.
2. a./7:y McNu~ HamPton ~u"ty HStflth Dept.;
Phone (317) 776~8500. FAX (317) 776.8508.
"","""",,ICom___lSit
1or~
07/21/2006 13:24 FAX 3177788508
1 317 846 4158
Apr-07-06 02:03P LQPpart&HQnslQyMortCarma
B4/B7/2elll; - B~;19 317~712255 CARtoEL UTILITIr~
H-'R. 1".2llE!fl C1'5iJ::/1 INllJ"",, ~~
JlAR..2HOOs IiF.D 11127 All
HAM CO HEALTH DEPT
~ 003/003
P.03
FAll NO.
"1;). 19~
PAGE B3/eJ
P.V2
P. 04
CJn_~A A /[.~.
IJanatullll M&IIf.a l_ret (at "'PI
.........
~7;:;~~~ _ 7-;'1-0,
. CI!RTIFlCA'T'I!; OF AUTHORITY
DIIt&
4- 7- ~(,
-
'--
Un_ fIIo Pflr18IlflMl of ~uty (lnifi8na CocIUll H ""l. , tJenIb,v lI'll'Imr. IlMtIr aIlth, tIIat l1li 01__
Infonllllllon , hIM! P*4d8Il111 t'". .pplloatron for donIarlfian permit r. Vwlll/llf 8l:iCIBIIfI, ID the
beut of my lo1vwIedg. IIIIlf 1M"'" 'nd 1111'1'1...,. not Icr1l1Wlnlfy or 'nflonCllonally """"ll" Ill'
~ I!IJ)' lnIormGison h1t~llld blnerto hicle, OHou.... ...ow-.. mI....d h ~
I)' CCIIrrmunlW 1II'*e1l MQardllto tIleln#h of ffMl matlsm "llrIoaod ~'".
Pllnher, 'DaGert thallll/n ItlG Ill1lP8rW awner, Qr tIIlIlilllthwf:lQd lIIId lIIwflJ'" appe/tlllld 'l8Ine af
tll& -~l. ~ 1m.v.1il5P""",,, f1Iltficlrlb' IInd /M'll'lre!on hm tho ~rfll) (ane! Invone liIIl'IIa
I'lIt:l:lnIlIlI 'ntemet Clf' OIJler rnto/'8lA 1I11f1e /llVpe'rM, e.lIIl1q 111.. requ.ted ~. .,.., 1m 18I1JM
10 Ifllfclmfl~ .nd lie.., hlhldecc tile CI1r tilt 0fInritt1 f'rclm any et../ln, rllWnrt, dlllltlllUl. CIl'ltll'!llll_
.~.... ... :""''''................ -..... """,~-
4/1-4
JIll- · SIgn_I'D " / ~'37
.D S . -1/ ,.r". 57~-'1~. $/7-Sc/&-<<:?/1
- Ilf.Ne L. MITt? "'u_ Wse-OSi.'
(NlI.... IIIfIlle1f) Apji PfIonll ,
'15 E. .;(1'111; Sk. ShU.td/iN :'Dv V~~
ApplivGnt's AdcINDlI CIty. liT ~
-
-
8l'A11: 011 INOIAlI/A )
~.,:r..J.~..~~
-'l't-." W1l11lt1ll1m1llf, 1/ NcltIry"Ullllo for m~(', tl n ~ Sl$ otlhdlma, """'".
~cl"\'1........ ~ 1. <3._'. \. \... and 8dcr101111oJdgq II'IUXlII;qflOll eft!>> 1D/wgaIng
/~,,~~\}.+.li_da,yOf_:t\~~\ \ ~20.M...
i ~ " ~' \ ':"'" J,
. ',.
r. .,...,..
~""""-..
.L\~
~J<y;f'\~
tot:.