• Application is hereby made for a permit to erect or alter a structure, install a fence, patio on or above ground, which shall be located as shown on diagram on reverse side of this sheet and to use the premises for the purposes described herein. The information, which follows, together with location diagram, is made part of the application by the undersigned. It is required to have the following completed before applying for a permit, when applicable.

    • Land Subdivision Approval.
    • Sewage Permit and design of Septic System/Public Water & Sewer Permit #
    • Driveway Permit, from Township or HOP from Penn Dot.
    • County E&S Plan approval letter/Storm water infiltration System Design and location.
    • Site Plan
    • Certificate of Insurance
  • LOCATION, OWNERSHIP AND PRESENT USE OF PROPERTY:

  • PROPOSED USE OF STRUCTURE AND/OR LAND:

  • APPLICANT

  • REFERENCES

  • Attach diagram with front, side & rear yard setbacks.

  • Drop files here or