HomeMy WebLinkAbout06120024 Signed Demo
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12/04/2008 17:35 FAX 3177788508
DEG/04/2006/MON 05:21 PM
HAM CO HEALTH OEPT
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p, 003
12/e4/2ees 14:46 317e7122&B
CARfo'EI... l1rILrTIES
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Demolit'on Permit R,qulrements
' 'City of Carmel I Chilly TownshIp .
8Ul1d1hg .. ~ Iia.r..._,_ 01; CIty ot C8InIel
OnoOlllbSquon,;, Carmel. IN ~ PII. (317"6714444 Fc(317)57'l-24lIIl
TO BE SUBMITTJ;;D WI'nl APPUCATJON": 'rWo coplea of... JocatIon ~ap-c/oarIy
iclentlfyfng h 8""'awre Dl" structures to' be demo'lahecf, 1M T_ Map ,.,.., n~ fQr
, th. paI'Clel on whIch the demolition Is 10 CCl:Ur, and tllI_1onn lllgned by'the IlpprOpftatg
dllpar1nJant.. ("A~ Is a ".,. Plitt fotm -n.",. ~ the lJuIltIIttg & Code
~1tJbrr:em.nt OJJt'ee) . "
NaTE:
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A separate permit applicstJon must be CCIIl'IpIeted,IlOI' Paroet. .:,
CertaIn lnspeauons iI!Ilrel'lJqulred l'9/ming !o pr1V8f8 walle. sapt/c 8YStei..... and fu~
tanks, prfar to dernol/Uoq, . ,
Should ap~ be l1i1QulreclltOm OCher, state or IoaaI government'entIIIes. or
utilili.. (othar-#1eI'l1hose ~ "erwIn). It fa tlu! sole n:ISpOnsIbjlity. ~/hQ
ClOtltJ'&etor of r8Conl to obIaIn I!IllC:h IJfIPI'O\I8Is.
E1dIdIna -, Well must be plUJmecl_rdJng to Well OnfJI'lMce ~
bbotlltt1_~, hpIfc sysfIlm muet be pl.UI1p8d and ftIl-c1 wltb uncr, or rernowcI. If MptIo
8}I8tINn Is to. be 11lUSed, It must be p'1l~ 011' untIJ AIlIc:Iy fer I'lkaIe.
PuIlJ I8nlc8 mIIst be pumped IInd remoYllCf fram 'buildlng..rlOl' P'VP8f1Y.
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~ on the rmes prgvided~lbe ~ hllSli\ 8Gpilnlts ~ ftdcfrr."th&n,th.
primary Blructurq OIl ,the P9rceJ.--p/ea5e fl/eo ~ude fhRt InfwrnatIon.) ,:, T' .
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FuW TAnIar
The CIty of Oamrel an.;:Var HamJItDn Coun(y Health Dept. muslperftjrm an lnBpoalluh P1IOr to '
. riomoIHIon. 1/1 orderiD 8pp/'01I9 t/lfJ demolition psrmJI, the IIPPIIctu7t 18 requhd te Wgn 'thJ$ ttJrm
Qnd abI::lln fhto slrnt__ of","" lridlvldllala IItdwI '-- (Thle _ be doll. Oy ~ to fIIeIr
omcei; M "'- n~ /IstItIii b8Iow) Inr.:J1H/e fIr,. oomp/RrId limn WIfh II" .,_~
sfrnmh_ (ON THE RIivJiIuE OF THIs PACi5) IIVhlllJ jlDu .ubmIt J/Ou"'''pplh;at/on pIi(t/nIge.
1_ MOI7fBH8nSIfIy.11>~'r<'la~:r. Wai8r>>eatment~ CltybfCwmel;
Phone (317) 071-2671. FA)( ~17) !J11-22M. ,
z. 8tury McNutry: H_mI1tDn Coun(Jr /1eaJth -Dyt.; .
F'hone(317)~ FAx(317)77~
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12/04/2006 17:36 FAX 3177788506
DEC/04/2006/MON 05:22 PM
HAM CO HEALTH OEPT
~ 005/005
P.006
12104/2005 14:4e 31757122G5
CllRME1. UTILITIES
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8~~{:t(=.L~'~~'Dat.
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CERTfFlCATE OF AUTHORnY
Onder tlm peNlNles of peljury (Inc1lana'Code'3S~-1).1 hen:lby af6rm, under 08th, t/1at ;d) gfthe
Information I have prpvIcIed In Ill. .pplle8tlon for dlNnolillon p1nn!'t III trqe Nld~, IiO the
best ofmv Jcnowledg.. -iId belief. irnd that I haw not knOWingly or Intentionally Pf'C;IVIcfed or ;
omltl&d .ny IrIfcmI:JlIlfJon IhIItweuld tend to hide, ~1'8, or othwwf8o mJa'-d ttN Depw1ment .
of COmmunity Servtces ngardlnlJ the ll'UtI'l tit lhl!l matlenl dW ...., th.,..n.
Ful1her, I..sert that I am me pro....~ o.wilw, Or Ille .UtJlCllfmd and lawfully appolntad IIl8INlt of
tm9 ownN(.), that I have ~..authorlt)o and f*II'~n fttm the 0WII8r{8} (end ~ wfffl.
nlClll dQ(f In""-t or OlIIer Int8rutJn the propeI:lv); to take thla ..querdBd .action, ancl !hilt IllQlH
lD indemnify IIId hold btuml8s$lhe. ClIv of Cannoll'rom iIII)' CII.un, '-un, demand, eM: ~~ I'
w~r lllielng out of, or - . result of, this I8qUM Cl/'tha .clon. oftha CItY of Cannel.
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