HomeMy WebLinkAbout07010129 Signed Demo
FAX NO.
~010/011
IilJOOS/011
PAGe: I!lS/ll
IiiJOH/016
p, 03
01/18/2007 17:22 FAX 3177788508
01/16/2007 15:07 FAX 5458165
e\m~~~~l, 1-~.:.9.e m JUmitS!
JAN-Oe-2007 rUE 10:~8 AM.
HAM CO HEALTH DEPT
JORDAN
JC~OA~
CARMEL UTILIne:s
~~,. ~
."'~ Demolition Permit Requirements
crty of Carmel I Clay Township
'....., . B~Vetn~ iii c"'"" 1!~"'rc:lt"'lt~l: Olty of Ol!rmel
~....... C:'ne c;fl'f; .~~gre; C&rmel.'~ 411032 Ph. ~'?') 1I'7'~ F'..., (SiT) 5"1.24111>
TO IiII SUBMITTED WITH A"PLIOATl~"1 Two copra. of e IIlte locetlon map-olearly
Identifying the .rructure ar structures be demolished, thlJ Tn MilIp percel number for
tho pa/'CCol on whleh fhQ d"molftion Is to occur. IImet n,l. form .18n~d by th. appropriate
d.paJ1/t'Nonta. r-A'Pj!JII~tlon III /I rh'6a.pltrl form flvrlilabl. from the ~uJldJ"!1 & Code
EnforcQment om".)
NOT.!::
.
A sepst1fte permit /application must b. OQmplated plJf parOCiI.
Certain inspectIons ere reqUIted rl!l18t1n~ to privet. welle, Ul)tfc IY81emG, 6lnd fuel
tIlnke, prior to demOlition.
SI10ula approVIIla bl 1'8~loIlred from ether Steta or local government entities, or
utlJltle. (other than those addren_d hereIn), It la the 11101., "'.ponslblJ/ty of t/'1...
oontrsc.torof tol;Qrd tg Qbtaln I!ui::h apll/'QVsla. .
ExJ5t1no WSlI: Well mUBt be pllliQod sc;:Corc!lng to w." Ol'dln'noo A-lJ2. ~_~r tI~ "1 .
I&lstJno ..!:IV,,} /i1epUc .~tllrn mu.t ~ PLlmplld an" fill.d with sand. or remoWd. If 118~;.. el
lIy&'tem III to b. rellsed, It must be pluOc:red off until ,....d'y tor I'1I-US8. ;b~... ~
61!J/ nmks: Fu...1 tan9 must b. pumpDcI and remOVed from burldinij ~mllClr pl'e;l~.rtv. ...e r
~, 'IX - /' --+ 6,"~Q P<y
,~?/6 I~/. 9~ .~"'j'~~ . .
A ';'"""0 on. # TlJfM4PP"".'# ~
''I'uc.:6Jt?J'I,~ b~t) e:~~ &. ~~z.'...M.~~jt)
O""n. III am _"d 'j.., ~
..
.
ArltJftiQflfll $tn.t~tu,..(s) on en-: Y.. /r1f:j) (If yes, p/esse rl$t the /'lUmber Ilnd type(s) ot
ettuO!ulll 0" tl'll! lInea provldld. If ~me 01 ~tn.Jetures has _ IIp. rate 8tr~l!It addrells tl'll!M the
prllT)liIry stnJcture Eln th(l PI!l~/-p/ea.slt also InolYd. that InformatIon.)
~
........--
'nle CIIy Of Cl:Jrmel snd/Q/" Htl""/tQn Ogunty H8flJ1l7 Dl:Jpt. mlJ~t 1'8,*,"" fill Iflllpeoflofl prtor to
dtlfT/Qlition. 'n offkJ~ ~ "PPfQv. the demDIIUon pttrmJt, the 'PP/IOlInll. f'fIqUfl'eQ to sign /hIli form
.ntlt>btrJ/n the ~/CI"~ the l (Thl. CQII /;Ie tlons by FAX't) th./r
Off/CBs, .t the nUm~8I'.'1s1 below nt!JJUd. this rIIOmp -_d 'fOrm wIth aJlJpnf'tJDn.r,
SllamJtu"t! (ON TH. flfEVEftSt: OP 'HIS r"""G.EtI when YOl.t submit J"Qur ilpplJOatlon prrcklS/G.
1. MrN'ffa H~J&y, $UPl81Vl.orl W.w T,...tment Opo,.tif!]n~. City 0.' C'm._"
v PhOne (~1r) 571.2873. FAX ('1'/') 511-226$. I
2. Sir/)' MeNulty: F{arnlltctr County H../th ".pt.;
Pholll! (317) "'$'B$OO. "AX (317') 716."08.
BlP......_IlI_..._ho""'>Jt
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FAX NO.
~ 011/011
~010/011
PAGE D7Ill
1aI015/01e
P. 04
01/18/2007 17.23 FAX 3177788508
01/16/2007 15:07 FAX 5458165
Dl/16/2DEl7 l~;ee 3175712265
01/0&/2001 1':54 FAX ~~5e185
J~N-Ce-20a7 rUE IOi~B A~
HAM CO HEALTH oEPT
JORDAN
CARMEL UTILITIES
JC~C~N
ft1-::..r .4, fk. .. ~ ~
. Signature: Morrh. H"neJ-y (or "'pn or - bat&!
.-
~ t _ . __. .J' (l/, I~. / ~AL.d hvru. IT-I;.
~:~~ (<lrrvp",."'YttvO) (:late
J-- /~- o(
( //lL> /0 I
J .
CERTIFICATI Oil AUTHORITY
I.Inder the pen.IlI.. at perjury (IndIan. Code alS044-2.1). I h....by .mnn, under C1~th, that Q,U of the
Infornlatlon I n,,_ pl'OYlde<lln thla appltolltlon fqr damolltlon pennlt I. tnu. IIncl.....urebt, to the
l;..t of my knowl.dlr- and bellor. and that I hllVe not knowlnlilly or Intentionally provided or
..ml~c:I.ny fnform..Uo" thllt would tttod to hldlll. obtau"" or gtf1erwla" mislead the Department
of Oommunlty Servloq rwQllrcflnll ihe m.th oIth. m.tI.~ add,.a.lK! therein.
Further, I a880rt thaI J am the properiy llwn.r. or the authorlzed aftd 1.wfUlly epPQlnt&d Ager\t 01'
the ownar(II), that I ~Iav& llxpnlSS Ruthortty snr:! permi8slon from the ownar{e) (cuid Ql\yOne with a
raCQrded Int.,...t or other tnteNlat In tile propert0. to blke thle ,.q".ated lIIetr,,". ,tiel thet 11ISAI"
to rndtmnlfY line! holld harm I... tI10 City of Carmel from .ny lCllIUm, laweulf, demand, or damagee
wheta04lVllr:ulalnCl out of, orlll.. a result of, thlll "'CJlJeet Ol'the1l4tlon. of the City 01 Carmel,
r.gan:lrng llama. - . .
Ap
:::Tnra?-.... Jj'l?'1d,I";;rr- ~P'
(Name prInt.d)
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App [Glnt'. dresll'
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Date
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STATe OF INDIANA _ )
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coun;y or /H Af..u" A'--.J
Sefo", mo, the underelE/J\gcf. . N..t.'Y Public for /J11P".e111?
apPu~i", If!. .....-:n~"
In$trumont t/'JIII q . ~'Y..t -r;;." Uffl ......,
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County, 8t.t. or In"'lIll', personllllly
and eoknow/adliled the exttel1tlCln r:lf the fo,.gglnlil
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