HomeMy WebLinkAboutApplication: DPDATE:
DEVELOPMENT PLAN / DP Amendment APPLICATION
Fee *: $928 plus $123 per acre.
DOCKET NO.
(Check all that apply)
DP DP Amend ADLS /ADLS AMEND Attached
Name of Project:
Project Address:
Project Parcel ID #: - - - -
Legal Description: (please use separate sheet and attach)
Name of Applicant:
Applicant Address:
Contact Person: Telephone:
Fax No. Email:
Name of Landowner:
Landowner Address:
Plot Size:
Telephone:
Zoning Classification:
Present Use
of Property :
Proposed Use
of Property:
*Note that required fees are due after the application has received a docket number, and not at
the time of application submittal.
1
OWNERS AFFIDAVIT
The undersigned agrees that any construction, reconstruction, enlargement, relocation or alteration of
structures, or any change in the use of land or structures requested by this application will comply
with and conform to all applicable laws of the State of Indiana and the zoning ordinance of Carmel,
Indiana, adopted under the authority of Acts of 1979, Public Law 178, Sec. 1, et seq., General
Assembly of the State of Indiana, and all Acts amendatory thereto.
Signed:
i(-4044x.a,
Owner Agent
Mark Harrison
(Typed) (Typed)
STATE OF INDIANA
SS:
The undersigned, having been duly sworn upon oath says ay at
athat the above information is true and correct and he
is informed and believes.
County of
for
(Signature of Petitioner)
/y1A1x3Q.v Before me the undersigned, a Notary Public
(County in which notarization takes place)
indntsvnl County, State of Indiana, personally appeared
(Notary Public's county of residence)
i'J�tt izlc
14,1-02,0i Soul
and acknowledge the execution of the foregoing
(Property Owner, Attorney, or Power of Attorney)
instrument this /9 day of Sepien6ve-
(day) (month)
LINDSEY SMITH
Madison County
My Commission Expires
September 20, 2017
, 20 /Z
(year)
// Public -- Signature
(jiNOSe4 SentcL/
Notary Public -- Please Print
My commission Tres:
ZO�7
Filename: DP - DP Amend Application 2012 Rev. 4-20 -2012