HomeMy WebLinkAbout06120024 Signed Demo
~ 12/04/2008 17:38 FAX 3177788508
DEC/04/2006/MON 05:22 PM
HAM CO HEALTH OEPT
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12lB4/2BB6 14,46
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~ UTILITIES
F'ASE e4/ee
Demolition Permit Requirements
'City of Carmel I Clay Town.hip
, ~&Code~ OIlvofClllll1lll
One CMI>__ Ooamial,lN o4<<l32 Ph. (317) 5i'1~ FtIK (817) 51144lle, '
TO BE $UBMln'EO WITH APPUCATlO~.1 Two CClplea of ill site location lnzl~arly
I~ntifylng the structure or ~ to be damo'lahed, ~ Tu Mep P8I'C&lI1Ull1bctr for
the ~ on which the demolitlotJ Ie Ia occur. and this t'oIm signed by tho IIIpprDprlate
deparirnentlll, ("AlJp/lcatkut.. fhJ'H pm ftNm ava/1able fro,,; the Bui(dlng & Code
~tOlWc$) ,
NOT<<: ,
.
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A,&epara1e penillt sppucatJon mum be oo'"Pleted per pan:eJ.
certain inepecllDns are reqUlr8d I'BfatIng to private we/Is, sepilc $Y$tems. and fuel
tanka, prfor to demolition.
Should Gpprovil/s be tequ/red ft'om olh&r S1al& or'DCIlII gD\lemment entllJes. or
utIIHIes (othlllr than those Ilddresse(l hefeln), It is the 8* ~ of the
oonll'aclor of r&cohJ to obtain 8IJeIt e'pprovafs. '
&lstltfa -~ We/I must be ptuwed atJeOrdlng ti; Well Ordlmmce 4..62.,
. t;;>rlaI;- - hpt!ll ~ IIttJst be PlRl'IP<<I J:Wf filled with sand, or A!IIlCMld. H sepfJo
syatam I. to be ~ It mllSt be plug".. off until reacfyfg~ re-use.. .
Fuel T.n'- Fueltllnlal'must be pumPcct and I'lNhO~ from building and/Or propeity.
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AddltJonttl ~tI) 011 #to: I No <If yes, please Ii8t the number and t:,ype{s) at
Prlma1Y~sIn.l 'on the p~eaa a also inoIude 1h8t 1n!brmalIon.)~
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The Cily of Carmet ~ Hamilton County Health Dept. must perlbtm IIIn /nspedJon fH*Jr to
cI~lI/on. In orrierto ~ file demo/IfJon ptUm/t, th" 1Jpp/k:em fa requl1ed "1I/g11 fhla/onn
anti obta~ tho 1!IInnm....~ of.fhe/~"" IlMrad It-row. (T7rIa oa" be donG by FAXfD tItWr
alJi-, fit tIr. num/Jenr fl$k/Jd beto I",;/ude t/JIII COmp/~ fonn With eN ..~
SIfm.r!l,.. (ON T11lI RlNlIR:sE OF 7HlS PACE!) when you SUbmJtJlOUT~ ~
1. Mol'TIs H__ey. SuptWV/eor. MIIifeI' TlNtmeJlt Operatio'n&, CIty 01 Ca17l7e/; .
Phone '(31T) $'11-1IJ73. FAX (>>17) m-22tJ5.
2.. Iktny /IIcNlIfty: Hatnl/'mn Cllunty H./Ih C1vpe.;
Phon. (afT) 776 !l'500. I"A.l(' (317) 77fU606.
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12/04/2008 17:35 FAX 3177788508
DEC/04/2006/MON 05:22 PM
HAM CO HEALTH OEP7
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p, 004
1~/i4/~Pio ,14:45
31757122G!>
QllRoEl. 1,JTI..:rr.IES
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CER11PJCATE OF AUTHORITY .
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Uncler the P*Ml.... ~ perjury (lncIJane Code "-44 ~.1). I h8l'8b)t afl'inn, under oath, Ihet.o of 1fJ.
InfcHmsdlon I have Pl'OYfd.d In 8IIll appllqlfDn lor CIemolltlOll permit ,. trv.llhd llOCUrats. to the
be.t of lIlY ~ ..;d beIlef,lind that I haw not knowingly or InfantlOl1dr Ill'OVld.cl or
'i:>mJtfled any lnMrftlatl..., rhat Mlukt _d to hide, ~ or otIuIrwIN mlsl..1f thli Oepartmem
of'Communlt)' S,,",,- ~no the InIth of the rno6n. ~ ltIen.fll.. .
Fq~llI'. I UIlfII't that I Qm h pn\...-ty GWI'IW, or... ~ IUId I8wI'uIIy appoIftt8d agent of
thCI owner(s), 1hat I hllW elQlJ'eM suthOrtty end ~Ion from 1M ewn8r(S) (and anyone wItIIa
.l'eOOn:Ied I~t orotMrlnfllrMt Intftt ~, CO UUte!hJa lWq~ BCtIon, and that I agreo
to IrlcI8nI.nlIY IIrtd Ilo1cI harm... tIIo c", or Cem.ll'rom lUIY _1m. __uft, dMMnlf. or ~
'WhId8CleWlr ~ DUt Of, oras s ... CIf, thllll rtqlltlW or.... ___ of ttte CItY of c.nnoJ,
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