Name / Mailing Address s1

BUILDING PERMIT APPLICATION COMPLETE ALL EXCEPT SHADED AREAS - FRONT AND BACK Revised: 04/18/2016

OWNER Name (MUST BE SAME AS DEED) / Mailing Address Date: Ctrl # ______Phone # Cell / Home

______Email Address______

______Part of TL REG SEWER DIST?  Yes  No

Property Address  Same  Other______Estimated Value $ ______

BUILDER Name / Mailing Address New Address Req'd? ____Ag/Ops Req'd? ______ Empty Lot  Replacement (Fire? Flood?)

______ Single Story  1 ½ Story  Two Story

______Basement:  Full  Partial  None

Builder Phone: Builder #______Basement:  Finished  Unfinished

Property use:  Single Family  Duplex  Farm  Other ______Foundation  Permanent  Not Permanent Improvement Use: Personal Storage  Farm Use  Other  ______GRADE: 30”  Above  Below

I am using this structure for (list exact/specific use planned for structure; if for storage, list example items to be stored):

Eave Total Height Structure Width Length Fee Height Sq. Ft. to Peak Roofline Change? (Y/N)

Energy Path: Total Fees:

*Setbacks are measured from the foundation to the property line or right-of-way, whichever is most restrictive, when the eave is 16” or less. For eaves greater than 16”, setbacks are measured from the edge of the eave to the property line or right-of-way line, whichever is most restrictive. ______Applicant Signature PROCEED TO PAGE 2 - INITIAL, DATE, AND SIGN WHERE INDICATED

******WHITE COUNTY USE ONLY BELOW THIS LINE******

FLOOD ZONE? SURVEYOR'S OFFICE Zoning ______ILP # ______Exp Date ______Y / N Regulated Drain: Drainage Board Setback Requirements - House/Accessory/Deck: Approval? Panel #: ______Yes ______Side: ______/______/______Sum: ______DNR No ______Front: ______/______/______Max Ht: ______Elevation Assessment

Rear: ______/______/______Var #: ______Drainage Permit USE: Surv Initials: Required?

AP Approval: ______BUILDING PERMIT APPLICATION - PAGE 2 Completed Form Must Accompany All Applications

I understand that, should my building project deviate from what I have submitted in my building permit application, or should I not meet building setbacks as shown on my site plan, etc., I may be subject to a civil zoning violation investigation. I understand that a civil zoning violation may result in fines as shown below.

L White County Board of Zoning Appeals - Civil Zoning Violations - Revised April 30, 2013 L A

R The following fine schedule shall be applied if a civil zoning violation citation has been issued. The Executive Director, on

O behalf of the Area Plan Commission, may issue an immediate fine of no less than $10.00 and no more than $300.00. The F

D violator will receive written notice of the fine and be given thirty (30) days for payment unless arrangements acceptable to the E Executive Director are made otherwise. If payment is not received within the time frame established, a late fee of $50.00 per R I

U month will be added to the fine. All civil zoning violations are enforced according to Chapter 13 of the White County Indiana

Q Zoning Control Ordinance or as provided elsewhere in said ordinance. E R I acknowledge receipt of this document (may be signed by Owner, Builder, or Agent).

______Print Name Signature Date W E

N Note: If this construction includes placement of a driveway, you must obtain a driveway permit from either the City/Town Road

R Department (if within city or town limits or the White County Highway Department (219) 984-5851. O F

E Applicant Initials: ______R I U Q E R Y A W n E o i V t I Note: The applicant accepts full responsibility to verify that the proposed construction is compatible with the covenant and c R i r D t restrictions of the platted and recorded subdivision. s

/ ______s t Print Name Signature Date n a n e v o C BP #:______BP OR ABUTS AGRICULTURAL LANRDEQUIRED IF PROPERTY IS ZONED A-1 OR A-2,

Printed Name furtherdetails. 32-30-6-9initsentiretyfor review IndianaCode only its but or operation appurtenances, agricultural an of operation negligent the from resulting nuisance a for redress seek to right the up giving not rezoning. for request your of consideration or permit improvement location County White a toyourissuanceof Indianalaw prior areaware ofandunderstand you thisnoticetoconfirmthatyou White Countyisproviding from dust operations. noisefromlivestockandmachinery field operationsand of creation crops, growing and fields to pesticides of application land, to manure animal of application livestock, of property as feeding long confined livestock, with of so grazing to, limited law not neighbors is but Indiana include, may activity under by Agricultural operated. nuisance negligently not suits are a they constitute nuisance not do public operations Agricultural or operations. private agricultural from existing abutting operations agricultural protects 32-30-6-9 Code Indiana property a rezone or develop to permit improvement location Districtwithin White County.abutting anAgricultural a for applied have you because notice this receiving are You they may change. The conversion of one type of agricultural to typeoperation ofone another ofchange. they The conversion may REQUIRES

agricultural areas that agricultural operations may be occurring nearby thatnearby beoccurring and agricultural operations agricultural may thatareas type of agricultural operation does not affect thedoes typeoperation statutory of not protections provided agricultural ______By initialing& am to ______I the I dating By acknowledging left, that home to a residence, a CFO/CAFO, digester or other intense agricultural intenseactivity aother or home residence,CFO/CAFO, digester to This notice advises persons choosing to develop or rezone a property rezonea abutting orproperty noticechoosing to persons develop advisesThis will be entitled to build on a parcel abutting or near you and is not required not to near isrequired beentitledparcelabutting or and you will a to build on Effective July 1, 2016, if you build a new residence on a parcel a parcel not on previously residencea build 2016, younew 1, if JulyEffective TO: OWNER keep those structures 1,320 feet away from your residence. yourresidence. structures away keep thosefeet from 1,320 PROPERTIES ABUTTING AN AGRICULTURAL DISTRICT WITHIN WHITE COUNTY WHITE PROPERTIES ABUTTINGANAGRICULTURALDISTRICTWITHIN ALL APPLICANTSFORLOCATIONIMPROVEMENTSPERMITSDEVELOPMENTORREZONINGOF understand and agree to to setbackand understandthe agree above exception. SIGNATURE - PLEASE TAKE THIS FORM TO OWNER FOR SIGNATURE PRIOR TO SUBMISSION PRIORTO OWNERFORSIGNATURE FORMTO THIS -PLEASETAKE SIGNATURE confirming that you have been advised of the foregoing and understand the same. the understand and foregoing the of advised been have you that confirming NOTICE OFAGRICULTURALOPERATIONSNOTICE WHITE COUNTYAREAWHITE PLAN by32-30-6-9. IC

Signature By receipt of this notice you are you notice this of receipt By Please