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OWNERSHIP
Privately
owned Publicly
owned
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Date
Applied:
Zoning:
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Applicant:
Address:
Phone:
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Indented
Use Other Than New Dwellings
Size: ft. x
ft.
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Liber Folio Map Parcel
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Contractor:
Address:
Phone:
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Lot
Dimensions: % lot
Coverage:
Area:
Width
(Front)
(Rear)
Depth (L
Side) (R
Side)
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Principle
Use Yards
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Accessory: Yards
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Front ft.
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Front ft.
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Water
Supply/Sewage
Individual Existing
Community
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Right
Side ft.
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Right
Side ft.
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Left
Side ft.
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Left
Side ft.
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Rear ft.
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Rear ft.
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Number of Off-Street Parking Spaces:
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If Commercial, number of employees:
Working time:
hours:
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Type of Improvement
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Type of Use
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Fee:
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New
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One Family
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New Dwelling
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$
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Addition
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Two Family
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Alteration
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$
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Alteration
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Three or More Family
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Other
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$
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Repair
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Swimming Pool
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Demolition
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Garage
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Carport
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Other
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Other Size: ft. x
ft.
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Offcial use only:
(comments)
Inspected:
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Approved: Yes No
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The applicant hereby certifies and agrees as
follows: (1) that he is authorized to
make this application: (2) that the
information is correct: (3) that he
will comply with all regulations of Emmitsburg which are applicable hereto:
(4) that he will perform no work on the above property not specifically decribed in this application.
Any change with out approval of the agencies shall
sufficient grounds for the disapproval of a permit.
Signed:
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Action
Taken:
Approved
Denied
Other
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Date:
Remarks:
Additional
Permits Required:
County Building Permit
County Plumbing Permit
County Electric Permit
Other
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Mailing Address:
Zip Code:
Phone:
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Note: This permit
expires 1 year from date of approval.
This permit does not exclude the applicant from acquiring the other
state and local permits necessary prior to starting construction.
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Zoning
Administrator:
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