HomeMy WebLinkAbout07010128 Site Plan
FAX NO,
141006/011
1i!I005/011
PAGE 18/11
0009/016
p, 03
01/16/2007 17:22 FAX 3177768506
01/18/2007 15:08 FAX 5458165
1/16/2887 14'58 3175712265
801/09/2007 11:'~ rAX "458165
JAN-08-2DD7 TUE lOl3S AM
HAM CO HEALTH DEPT
JORDAN
OARME~ UTI~ITIES
JOAOAN
l,_..
Demolition Permit Requirements
Cit)' of C.rme. I Clay T"wnlihlp
e~Udlnll & 'CO<le cn",rcernen~ Oily.f c...rmel
One elvro Sque~; Carmel. IN 4!032 i='h. (311') 571-24# ~.,. (:117) S71.24QD
e.$U&Mlm' to; TwQ oopi.. of a sit. ICII;.tlon map--clearly
~O ~lfyl"CI the lItruCltlJl'1I ar .structl.l~ to be demoliShed, the Tax Map paroel numbsr felr
th:nplro.I on wJ1~'~_~':J8w GtJ80mn ~~I~~'!:e:~:'::~~ea~?~~J:~~%'~~~~~,,~ a:~':~;'8t~
d.p.l"lm.nts. 1 ,.,p,..r~~ r
EnfO/1CemQnt 0"(08)
NOT~i
.
A ..pllr.liI perm II epplleatlon must be completed per parcel.
Certein inspections lare requIred reJetlng to prlvatll wells, Ileptlo syS'temlil, and fuel
~nk., prIor to C1emoJ/tlon,
ShOUld approv.18 be ...qulrad from other Stat. or IQCIIlgr;lvernment Iilntltlell, or
ul1l1tles (0'Ih.~ thGll'llho.. E1dd~Gliled hlllreln), it is thE! solo responsibility ~f th&
oontrac:tQr 01 rectlrc! to obtaIn such approv~18.. ___
EYl.,tlnrJ well: W.II muet ~ plugged lOOClrdlnll to Well Ordinance A-62. M ~ ( h-<1!"
lkf.Ung ....~ ~Ie"tro Iystem ,,"un b. pumped 8nd filled With san.d, C1r rem oVid, It ,'pflcAt-.
eyetam /8 to b. reus.d, It mu.t b. pluaged off Until f'lIsdy for n.us&.
Fuel Tanke: 1'1.101 tlrt' mUlrt b. pump.d and ...moved frohl bLllld/nv and/"r Prilp.rty.
--- ~ 70S ~ 9tf f, 5'-Ir,e-7
Addrru. Dirt_mol e" . -I>" ~ M.P. ~.:z;
~~:if\f. :JZ,<;4tL~d~. L, jJ. 6 ~ &":96 q7 ~Yf . ~Z9t:J
"It .m. an lIt."_
AddfUonel Structure/s) o~ sl,.: Y.. lifE). (If yes, plea Ie list the number and tyP9(S) of .
SltrtJcturel on the lines provlded. If "ne of t". structures hills II se!:HIr.l. street .!lddf'8SS than tf'1a
prlm!lry atrtJClure 0" the perce!-Pleal5e 1II1so InolUde IITIII Il'IfolTl1atlon.)
.
.
-
-
-
-
'Tho Oil:y of Oarmel ~l7cVor HlImuton ~"nty H9a1th D8pt. mu_r parforrn ~17 In~~f/Qn prkJr to .
d~mollflOn. In erd.r to IIpprove the d.mallfJon Pwrnit, the apP/lt:I.nt Iii requ/,..r/ ~ sign this form
Ind obtrlln th.l1lan:fO~ a~~Q /nd/v/duaJJl""fl>d be/oY(. (ThIs csn be (fr:me ~y M4Xto theIr
Of!/o.., .t rhrl n<Jmbl!i1/'S: 1li1r. ./ow) Include. this etJttrpf$tfJd form With _If lIln~'i1c"rl.t&
lIl,arr.tUrBR (ON THE IUIV1!!RSE OP THIS I'"ACII'tl When yoU $ubomJt your .;Jpl/c. on P.t1kego.
1. Ml!ltPls HlifUlJ.y. 8up4If'VISJor; W.,.,. TI'Pafm.nt Op.,..t/rms, C:rtyaf'a.rm.~'
..... Phon. (317) 671.2873, FA)( (317) 871.2Z6~. ,
2. 5,1'1'1 McNUlty: Hamilton CaClnty H.lllth tJ'pt;
Phon" (317') 7,?tJ..$(J(). "AX (31.,.; ""'.I$O~;
81~""""""".II'I... _n h_
1 oil
F A~ NO.
~007/011
1iiI006/011
PAGE 11/11
~ 00910 1Q
P. 04
01/16/2007 17:22 FAX 3177768506
01/16/2007 15:06 FAX 5458165
al/16/2ea7 14:Se 3175712265
ol/oa/~007 11:53 FAI( 545816'
. JAN~D8-2001 rUE 10:36 AM
HAM CO HEALTH DEPT
JORDAN
CAAMEL UTILITIES
JORDAN
~i'" '-A f~'.~
Sil1nBture: oms 18ns'8Y (or "pre..ne )
"-'"
Dlt.
)- /::J.. - <9"(
~ (lCJ~~ I~... 0lfk,J1:;) III/clo!
Signature: ~~UltY'(J ~~""I~ '--~te
CERTIP'ICAT!! O~ AUTHOFt'TY
Und"r th6 penaHles of perjury (Indtenll Ood. 35~-2.1). I hareby IIfflrm, unc:lQ( QlIth, that all of th.
Information I have provided In thIs appllClatlCln for dam om Ion p8rmlt i. trv. and IIccurate, tQ the
tint <>l'my lenowled,,_ .net ~1I.r, anti t1l1lt I hIIvo not knewlntill)' or IntantlonaUy provIded or
omJtled IllY Information that would telld 10 hide, obsQurG, or othl'llWls9 mlsl821d tho OBplrtmen!
gf Community eervlces rugllnfl"g the trutl'l of tho mat91'll addrell...c1 the"'I".
Furth.r, , 1a..1t thllt I am tho proparty "wnllr, or tho llulhorl%lId and la......ru/ly appDlntllrl iIS,nt 01
thll owner(c), that I have ll;IC"",~s auth"rtly "nq perml','on ftcIm ~ht owner(a) (.nd Ilnyone With a
"'''orded 'nl....st or Glher interw6t In thll proprl~). to take thIs lliIquootlld zsctlon, and th.t I Jlare~
to Ind.mr11l'y and hold htnrnllilss the City of Carma! from eny claim, lawsuIt, d''''f1nd, or dlimllg8S
whabroevllr Brfsll1l1 C1.ut of, 01" llII . r..ul! 0', tit.. ~uelllt Ol"th. action. of the CIty 0' 0_.",,,,,
regote)n" 8sme. b
f!~
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c.~
81-
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. 7::y6' ,,~/-, ~ Vg>
ON t ST - Zip
STATE OF INDIANA ).
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COLlnl)' "f /1l ~"'D Y1 ...J
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~h. e Ji ~ ~ ..."....... n na, porsonllUy
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' a w a""now edged tll, ~cuf/O" oft"1I for.oglng
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