HomeMy WebLinkAbout08010025 Signed Demo01/10/2008 14 07 FAX 3177768506 HAM CO HEALTH DEPT R 002
JAN-18-2008 01:53P FROM: 3177187150 j-0:13i7776B506 P.2
0
• E City Of Carmel
4-W6 oa :DEMOLITION PERMIT REQUIREMENTS
To be submitted with appllcatlon*: Two copies of a site location map, clearly Identifying the structure or
structures to be demolished, the Tax Map parcel number for each structure to be dernollahed, and this
form signed byt a appropriate departments. (`Appllcatlon Is a three part form evellable from Permit
Services) i
Certain Inspections are requtred relating to private wells, sepdc systems, and fuel tanks, ?rlor to
demolition.
F Lag net well: Well must be plugged according to Well Ordlnonce A-52.
Ift?
Fir/stl _sepUc: Septic system must b ?'o? rernovdd.cIf septic
pumps and filled wltt earl ,
system Is to be cause , s be plugged oR,until ready or -use.
FuelTAnks: Fuel tanks must be pumped and removed from building an dlorl property.
Additional Strudtures: Yas / No
1-1 - IV -O(a -:O1 -0(r-OC74.Oor
Tax Map Parcel N!
**If yes, please?st the address and Tax Map parcel number for each addltlonal *ftctur?e on the
reverse of this rm.
The Cray of Cannol and/or Hamilton County Health Dept must perform an inspe6on prior to demollflon.
In order to approthe dernolftbn penr>!t, applicant is required to sr this form and X W the
nd uals lists below. Include this completed form with all Hate sddnalu when you
submit your applic on package.
1. Supervisor: Water Treatment Oparadons, iplty of C el; (317) 571-2481
2. BarryMc*ul(? , Hamilton County Health Dept.; (317)776-8608..-
,---) . /7.
3.12 - ?I i M_ 7114F, 1 mumIJI'd&6do - &0? ?1
Applicant's Tele horse Number Signtlu re Date: arty McNulty tor!,rapresantattve)
NOTE' Should
approvals be required from other State orbt+alQovem nt' entitles, or ufflitles (other
than those addressed herein), it Is the sole responstbifty of the confregor of record to obiain such
approvals.
Under the pen!*7 perjury (Indiana Code b8?t-2.1),1 hereby affirm under oath that al of the Irtom on I h provided in We
application for demol on permit le true end mcirrat+s to the bast of my knowledge and b#ilef, and that 1 have n knowingly or
Intie0Vonelly provlded or omitled any InfomwCon that would tend to h1de, obecum or othprwlee ndsla0 the Q rtment of
Community Services arding the truth of the nU tsra addMood tfteretn.
80ding F Code Ekort±ement One CJvk Square, Carmel, IN 48032 Ph. f$17) 671-2444 Fad (317) 571-2489
31%rmltmernoonA p" haroow
SCANNED.