HomeMy WebLinkAbout05080104-Signed Demo
08~0B/2005 08 47 ,FAX 3177768506
HAH O0 HEALTH DEPT
~ 002
PAGE
Demolition Perml tRequirements
· CIt_y of Carmel I Clay Town~hip
O~ ~ ~u~e; ~, IN ~ Ph, ~lT) 571~ F~ (31~
& Code
A
tanks,
f~. mu~t ~ mmple~ per-parcel.-
requ red relating to private wells, Sel:~C*~stems, and fUel
utllltle$:(other than
contractor of record to Obtain such
..we. mum be
n~lnan~ A.82.
er removed. If septic
Fuel tanks must be pumped and mlT?oved.from building and/or
Phone
~71.2452.
0~/04/200§ 14:06 S175712265 C~RMEL UTILITIES P~E 02/02
Demoli uirements
ty of Carmel ! Clay Township
One Civic S~uam;.
a~ locafien map~l~ly
~he Tax Map pa~l numar
r, and thls farm signed byt~e apprepriate
available from ~he ~luildi~lg & ~
completed per parcel.,
f to prlvat~ Wells. septm'systems, and fuel
~ or'local government entities, or
herein), i{ is the sole responsibility of the
3btain such approvals.
plugged .e,~ording ~ Wel
Fuel tanks must be pumped and remmmd from building and/or
(If yes, please list the number and type(s) of
a separate street address than the
also include that information.)
required to sign ~his form
08/28/2005 08:47 FA× 3177768506 H^~ CC HEALTH DEPT ~003
88/08/2885 la~05 3178§27649 ~C~T~AN ~ ~NC PA~E 03/~3
' Dat~
Under the
Further, I
the
reg~ng
CERTIFICATE OF AUTHORITY
, under o~th, thai: aD or,he
to the
Dep~l~n~nt
AppiJc~nb~
Ghy,. ~¥ Z~p
.Goun~, ~(atl of Indhna, pemonally
· _ _ ;md a,:knowllldgidthe~lr..utloll ofthe foregoing
08/08/2005 08:47 FAX 3177788506 H^M O0 HEALTH DEPT ~001
r
HAMILTON COUNTY HEALTH DEPT.
ONE HAMILTON COUNTY SQUARE
SUITE 30
NOBLESVILLE, INDIANA
PHO]
FAX-' 317-776-8506
COMPANY:._
COMMENTS:
Totzll number of pa~je~
IF YOU lDO NO~' RECEIVE AM, THE PAGF~s P~ CML B/((~C AS SOON AS PCk~i~IBLE
GONFIDENTIALITY NOTICE
permissible. If you have
notify us by telepltone mt 3t7.776-6500 to arrange for ret~m of the original
dooumentl:, Th~nk you.