HomeMy WebLinkAbout0179.97 Application C el lay Pem�it No. /�,q::'9�
o�nS P:; Applicafion for Da����
� Improve�rtent Location,Peronit � Roii Fne
This�.pertnd�is�valid�bnly-it consVUCtiort is�sfarted witfiin��120 days of issuence date;all wnstruction�musf be completed�(c/o issued)wittwi-2years of issuaiice;
date�.unlessan�extensionoftimehasbeenofficiall ; ranted.b letter,b theDirector;De artmentofCommuni Services. �-
� NAME PHONE �FAX
BUILDER I � Z'1, S .i ;3. JS�Z � Z S
SIREEf CITY STwlE T!P
D' : Ma `n cz' Z N - 03 Z
TF,NANT NA11iE
°- ..,. . ....:-.. .
(if a liceble)
NAMk PNONE FAX
OVVNER �
SIREEf� CI'IT: .SfATE ZIP
LOT SUBDNISION SECTION
I.00ATION y�' �'aC�
_., . _. _
ADDAE55 OF CONSTRUCf10N
���SS'Y �"c/ . ; ���
_ _ _ , - ,
A. 1'PPEiOF�CONSTRUCTION Do plans include a ch? F. TYPE OF.,IlYIPRO�'EMEIVT
1. �, Single Faznily �Yes O No I. � New Strucwre
4. ❑' Commerc,y 2' �. P`dd'tion 'Porch_Room_
3. ❑ Mplti-Family Type_of 3. O Remodel ❑ Commercial Tenant Space
ial/Ind�istrial OCrawlsp � 4 ❑ Foundation Only
5. ❑ Fazm ❑Basement ��E� ` Demolition,
6. ❑ OTF�F2 ❑Slab ���j� � �` AccessoryBuilding
(Specify) -'! '��'� 7. ❑ Swimnung Pool
B. SEWER�, ���j 8. ❑ Gazage Detached Attac6ed
1. �II PnbGo- (NainB of System�G1 rrne �, G. Lot SpGt, YES _ NO �
2. ❑ Erivate(Septic Tank;etc.) H. Flood Zones YES NO �_
C. WATERc . � I. .Sump Pump YES �_ NO _
1. �{I Pubhc (Name;of System Y!1'!� Manutactured Trusaes YES � NO _
2. ❑ Pri`vate(Well' /f7
D'.. ZONING: .5 —� �: 9� �� bing,Contractbr IZ��T MODY �
E: ESTIMATED COST;OF CONSTRUCT ON j9 /OOS.Z�S
(Excludmg Land Value),:��O 0, U� � 9JPIum �Trcense# ❑BOCA or f�"CABO
i►!#'/4t#i�tittrti*rtrt##*4#�Ltitt##i#t+#�ftt*+M#ttk*tti#i #i#k*##Mtes •t►ii/*ti#rt*►si#ttt#rtrt►####ii*►*t+R�iiitt�t
The}Sndersigued'agrees that�any:conslruchon;reconsuucUon,enlazg reloc ou;or.alleration of'sVUCture,or any.c6ange in ihe use of land
or stivctures requested by llvs applica[i�n will comply with,and conformto- l plica le laws of;the State of Indiana,and the"Zoning Ordinanoe
of Caimel Indiena- 1993 (Z-289)and,amendmeu[s;��adopteci under authon o I.C. 3�7� et seq,-Genera]Assemlily�of the State of Indiana,and all
Aots_amendatory thereto. I furlher certify;that onlykitchen i,laundry,and ain,aze connecfed"to the sanitary sewer. I further certit'y
ttiaf;the constrdct�on will;uot be q'sed or occupie ntil a'Cerlifuate ojOcc n has been issued by t6e Department of Community
Services, Car.uel,Ind�ana �,/��� ��l
C�""-" ��i,�I/1�bUU'S �S. uspectionsNeeded:
r � � �f`����� .�ti'_:
j� �ootm derala6��� -Rough-ln eteeBase�
igiiaiureof.0`wnerorAu[t�orizBd.Sgent. `�(/�L ° ` "'
a E��'Site rz :Final' G10
/�larce,//�a 12o��v o Sdz:-2¢56 .r 3�qa�'� °`�d��� ��`�� �p�jr
(Piint) (Phone;Numbei)' .�SD SP�i�t�(��ootage) � � �00 ��11.
ir�aT GF'�OC',°` ``
SewerCapaci'tyAllotted' �(l.M�n�O: IQQ1 r, . � : ���,, �.; v�S���b
f�r.� , q,a��'�'�P
Plan Commission/BZA Docket#: �'� ,;�` tC, •
—r-
, + �*o- $� �fi�ofOccupancy: �.Sr�b
.__ . _. _ . . — Et✓ R,, ����,d�
�'��^�µ oQ� �e1
, _ ya�' ��'a. �G /
: �.p�Ci�O s� L ' , �.L
Reviewed/Approv Dept.of Community Services G\� Fee Received By •:��aN m��
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