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Thursday, January 18, 2018

Planning & Zoning Permit


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Planning & Zoning Department


Please print or type. All sections must be completed.

Demographic Information:


1 Applicant's Name
                                                                                                       Last                                                First
2 Phone Number Phone (       )         -                                          Fax (       )         -
3 Email Address www.                                          @
4 Applicant’s Address
                                                                           Street                                                   City/Village                        Zip
5 Zoning Request Address
                                                                           Street                                                   City/Village                        Zip
6 Subdivision    
7 Lot Number  
8 Tax Parcel # __ __ - __ - __ __ __ - __ __  - __ __ __ - __
                                            (Tax parcel information must be provided and can be obtained from your property tax bill or by calling the Pickaway County Auditor’s Office at 740-474-4765 or at http://pickaway.iviewauditor.com/.)

Permit Information

9 Zoned
10 Present Use 11 Proposed Use
12 Type of Construction - check each one and add dimensions as indicated:
To build a ____ story single family home as per plans supplied.   To build a fence
To build a ______ x ______ removable shed To build a deck/porch ______ x ______      
To build a ______ x ______ room addition   To build a ______ x ______ garage
Change of Occupancy __________________ To install a ______ x ______ pool
Other ____________________________________________________
13 Contractor’s Name
Contractor’s Contact
                                                                                                             Last                                                First
Phone Number Phone (       )         -                                          Fax (       )         -
Email Address www.                                          @
Contractor’s Address
                                                                           Street                                                   City/Village                        Zip
Contractor’s License
(If doing the work yourself, indicate so.  If contracting, contact the Building Department at 740-983-7172 for any licensing requirements.)
14 # of Dwelling Units
15 Approximate Cost of Construction $
16 Building & Lot Date A Scaled Plot Plan Must be Provided can be found at http://pickaway.iviewauditor.com
17 Corner Lot:    ______ Yes(C)  ______ No    Corner Lots have two front yard setbacks
18 Yard Setback Depths: Front Yard:_____ _____(C)  Rear Yard: _____   Side Yards: L _____ R _____
19 I hereby certify that I am the (select one)   ______ Owner   ______  Agent for the Owner

And all information contained in this application is true, accurate and complete to the best of my knowledge

                                                                   __________________________       _______________

                                                              Signature                                                                   Date


                                                              Print or type name of signer



The following items are the applicant/property owner’s responsibility:

  1. To assure that no structure is built on any public easement or right-of-way.
  2. To locate and verify property lines to assure that the plot plan submitted with this application accurately reflects the setback dimensions from those property lines. Where complete and accurate information is not readily available from existing records, the Zoning Inspector may require the applicant to furnish a survey of the lot completed by a registered surveyor.
  3. To supply a legal description of the property, as recorded in the Pickaway county Recorders’ Office, if required.
    1. Legal description attached. Yes _____ No _____
  4. To verify that the deed and/or plat does not contain any restrictions against such construction activity.
  5. To follow the Home Owner’s Association (HOA) rules and regulations, if applicable.
    1. Issuance of a Village of Ashville zoning permit does not overrule the HOA’s rules and regulations.
21 The Area Below is For Official Use Only
Worksheets Fees paid by?    ______Cash  ______  Check -Check #:____  ____  ____  ____  ____  ____  ____ 
Fees Collected $ ______    Mail-in  ______  Walk-in Date  
Date sent to review  
Processed by:   Receipt #  
Flood Plain: ____ Yes ____ No Historic District: ____ Yes ____ No Subdivision Grading Plan to be Uses: ____ Yes ____ No
Certificate of Occupancy Granted : ____ Yes ____ No ____ Temporarily    
If approved, this permit is conditioned upon obtaining all other required permits and is valid for a period of one year only.  This permit will be revoked if construction is not started within one year and/or if construction is not completed within a two year period.
On ___________________________, this permit was approved   /   rejected
Comments:   ________________________________________________________________
If approved, this is to: check each one and add dimensions as indicated:
  Certify the above application conforms, for use, with the latest zoning ordinance of the Village of Ashville
  Certify the above application conforms, for structure and construction, with the latest zoning ordinance of the Village of Ashville


Zoning Inspector Print Name:________________________

Zoning Inspector Signature: ________________________




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