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Rev. 1-1-61
ZA Form
PC Form
(To Be Filed in Duplicate)Sheet Datel-of 2.sheets
APPLICATION FOR II.IPROVt,MENT =,7GATION pec-, IIT AND CERTT ICAJ OF
No. y_,�'- L 8
Date filed
The undersigned agrees that any construction, reconstruction, en-
largement, relocation -•r a:!.te-,'&ticn of st--kctare, -or any change in
the use of land or struc.ures eques::ed b.- th.*,.s application will
comply with, and conform t(.. all appl cable laws of the State of
Indiana, and the "Zor.,ng 0-rdinmtce of Carmel- lydia.7a••1961," adopted
under the authority :.f Gn�.,p :er 174 or the ;guts of 1947, General
Assembly of the Stage of l:luianar and all act amandato-y thereto.
Name of Applicant ��.% c - �,r�, r, L`1, ] phone No.; -"6
6
Addres's of Applica-; <//�_ ,• -'��
'Name of Owner Phone No,
,Address of Owner �,� �;"�—
Location of Prope: tyc LoiNo. ;;i :� . Ccs t dation
Street No. or other descript+o:i c2' idea*ion
Present Use of Pro err �'—
Proposed Use of Property—
Zoning
roper t
Zoning Classification of Property~ -
NOTE: Application for an Improvement Location Permit must be Accompan-
ied by two blucprint.s of a plat plan of the property drawn to scale
showing lot lines, dimensions. ea:.aents; ut,.ljties, street widths,
and showing location of ar.y ez`_Stine -;,:uctures or proposed structures
together with a detailed written explariat:ou of the proposed Improve-
ments, and other information as muy be required.
SIGNED:,,t y
Owner
of<:Lnt
A Permit Fee of j..L.�.= a+1st accompany this application.
Permit Fee received byz..
2 J BUILDING COMMISSIONf O
A Title
RC# VtD
B�i�, I.:G COMMISSIONER
CLAY TOWNSHIP
B HAMILTC14 COUNTY