PRELIMINARY
APPLICATION FOR ZONING
CERTIFICATE
Chippewa
Township, Wayne County, Ohio
To the Chippewa Township Board of
Trustees: Application No. ............ The undersiqned hereby
applies
for a zoning certificate for the following use, to be used on the
basis of the representation herein contained, all of
which the applicant
swears to be true:
1. Location of Property
.........................................................................................................................................................
2.
Name of Land
Owner........................................................................................................................................................
Address of Land
Owner............................................................................
PHONE: ........................................................
3. Occupant
of
Premises.......................................................................................................................................................
4.
PROPOSED USE:
a. New Construction
..........................................;
e. Residence
........................................................................
b. Remodeling
...................................................;
f. Number of Families
.........................................................
c.
Accessory Buliding
.......................................;
g. Business; Kind
.................................................................
d.
Garage
...........................................................; h. Manufacturing
..................................................................
i. Sign Board Size; Advertising What
..............................................................................................................................
j. Is this structure or Trailer Coach to be occupied temporarily for ONE year or
less while constructing a
dwelling?
............................................................................................................................................................................
5.
Sketch of lot, showing existing buildings and proposed construction or use for
which this application is made.
Fill in all dimensions and
indicate which direction is North.
a. Main Road or Street
Frontage
e. Depth of Lot from Right of Way
....................................................................
Feet. ..........................................................................
Feet.
b. Set back from side of road or street right of
way f.
Dimensions of Building
.....................................................................
Feet.
Width .............................................................
Feet.
c. Side Yard
Clearance
Depth .............................................................
Feet.
Side
Feet. g.
Highest point of Building above established grade
...................................................................... Feet.
..........................................................................
Feet.
Side
Feet. h.
Approximate Cost .............................................?
......................................................................
Feet.
d. Rear Yard
Clearance
......................................................................
Feet.
6. Building: Use
..................................................................................................................
Number of Stories ............
Basement: Size
...........................................................................................................................................................
Usable floor space designed for use as living quarters exclusive of basements,
porches, garages, breezeways,
terraces, attics, or
partial stories. First Floor ............... square feet;
Second Floor ..................... square
feet.
Off Street Parking Space ..................... square
feet. Width and Length of Driveway ....................................
feet.
7. Remarks
............................................................................................................................................................................
Signed and sworn to this ............................ day of
..................................................
20.............
Witness:
............................................................ Applicant:
............................................................................................
ZONING CERTIFICATE
Upon the basis of the above application, the
statements in which are made a part thereof, the proposed
usage
is ............................. found to be hereby
...........................................................................................................................
approved
for the following district
....................................................................................................................................
.................................................................................................................................................................
Township Zoning Inspector
Date Application Received
.............................................................
Date Applicated
Ruled On
.............................................................
Fee
$ Paid?
If Refused, reason for Refusal
...........................................................................................................................................
SKETCH
OWNER IS RESPONSIBLE