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TOWN of ASHLEY Application: Improvement Location Permit TOWN of ASHLEY
Application: Improvement Location Permit
Date:

Permit
No:
The undersigned agrees that any construction, reconstruction, enlargement, relocation, or alteration of structure(s), or any
changes in use of the land or structure(s) requested by this application will comply with and conform to all applicable laws
of the State of Indiana and ordinances of the Town of Ashley, adopted under the authority of Chapter 174, General Assembly
of the State of Indiana, and all acts amended thereto.
Name of Applicant
Phone
No.

Address
Owner Name, Address, & Phone No. (If different from Applicant)


Address of property where improvement(s) will be located
Subdivision Name
Block No
Lot No.
Present use of the property
Note: Every application for an Improvement Location Permit shall be accompanied by a site plan, showing the location of the
structure(s), improvement(s), or use to be altered, placed, erected or located, the dimensions of the lot(s) to be improved, the
size of the yards and open spaces, existing and proposed streets and alleys adjoining or within the lot(s), and the manner in
which the location is to be improved.
Signed
Signed
Owner
Authorized Agent
This is to certify that $25 00 non refundable fee was received this
day of
for an
This is to certify that $25.00 non-refundable fee was received this ___________ day of _________________________________ for an
Improvement Location Permit
Receipt #
_______________________________________
The bottom section to be completed by the Zoning Administrator / Inspector
Type of Permit:
House
Garage


Deck/Porch/Patio
Modular
Signs


Roof
Mobile Home
Accessory Building

Commercial
Fence
Additions

Industrial
Other
Size of Structure(s)
ft. X
ft.


Basement Yes _____ No
Area
Sq Ft

Bldg Ht

Ft
No. Floors
Type of material used:
Lot size:
ft. X
ft.

Current Zoning Classification:
Set Backs:
Ft. from front property line
Ft. from right property line

Ft. from rear property line

Ft. from left property line
Estimated cost:
Estimated completion date:
Approved to obtain building permit:

Date:
Zoning Inspector or Zoning Administrator
Revised 5/10/2006