ZONING/BUILDING PERMIT APPLICATION

Name of Applicant: ________________________________________________

Address of Applicant:_______________________________________________

Phone #: ___________________ Date Submitted:___________________

Property Address: _________________________________________________

Property Owner Name:____________________________ Phone:___________

Property Owner Address:____________________________________________

Existing Use of Structure/Property:_____________________________________

Proposed Use of Structure/Property: ___________________________________

Zoning District ____________________________ Acreage ________________

Dimensions of Structure:___________________ Height of Structure__________

Type of Construction:_______________________________________________

Distances from property lines: ________________________________________

Name of Contractor: _______________________ Ph: ____________________

Estimated Cost: $____________________ Completion Date: ______________

Please list any other pertinent information:______________________________

________________________________________________________________

Water Supply ___________________ Sewage Treatment ________________

I hereby authorize the designated Township officials to enter on the property and to investigate, inspect, and examine the Property set forth herein, including land and structures, to determine compliance with the Zoning Ordinance and to determine the accuracy of the statements contained herein.
I am aware that I cannot commence excavation or construction until the Township has issued a Zoning Permit. By signing this Application, I certify that all facts in the Applicant and all accompanying documentation are true and correct. This Application is being made by me to induce official action on the part of the Township, and I understand that any false statements made herein are being made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities.
I expressly acknowledge that the issuance of a Zoning Permit is based upon the facts stated and representations made in this Application. I expressly acknowledge that the Township may revoke a Zoning Permit if the use and/or structure for which it has been issued violates and applicable Township, County, State or Federal law or regulation. I also expressly acknowledge that the Township may revoke a Zoning Permit if it has been issued in error or if issuance was based upon any misrepresentations or errors contained in the Application or otherwise made by the Applicant.
I acknowledge that the holder of a Zoning Permit is responsible to insure compliance with all applicable Township Ordinances during and at completion of the work authorized by the Zoning Permit. I acknowledge that the Township requires a final inspection be performed by the Zoning Officer and that the Township issue a certificate of use and occupancy before any structure which is authorized by this Zoning Permit may be occupied. It is my responsibility to insure that this inspection is scheduled and the certificate of occupancy obtained before the structure may be occupied. I acknowledge that if I occupy or permit the occupancy of this structure prior to the issuance of a certificate of use and occupancy under the Zoning Ordinance, I will have committed a violation of the Zoning Ordinance and will be subject to the penalties and remedies in the Zoning Ordinance. If the Township is required to perform an inspection after the structure is occupied, intending to be legally bound hereby, I agree to pay the fee established by the Township for delinquent inspections.
Nothing contained in this Application shall be construed to relieve or limit the obligations of the Applicant to comply with all provisions of the Zoning Ordinance or to waive violations of the Zoning Ordinance or any other Township ordinances or to stop the Township from enforcing Township ordinances, including but not limited to the Zoning Ordinance.

Applicant's signature ______________________________________________

Site or Plot Plan (show all property lines, structures and driveway accesses)