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Madison Township, Lake County, Ohio
APPLICATION FOR ZONING PERMIT
Residential New/Additions, Accessory Structures, etc.
Estimated Cost of Construction: $
2065 Hubbard Road
Madison, Ohio 44057
(440) 428-1120
Application #
Application is hereby made for a Zoning Permit, the statements herein are made a part thereof. It is understood and agreed
by the applicant: that any error, misstatement or misrepresentation of fact or expression of fact, either with or without
intention on the part of the applicant„ such as might, or would operate to cause the issuance of a permit in accordance with
this application, shall constitute sufficient ground for the revocation of such it at any time. All provisions of the Lake County
Building Laws, Sanitary Regulations, and the Madison Township Zoning Resolution and Madison Fire District shall be
complied with whether specified herein or not.
This application when APPROVED constitutes and becomes the Zoning Permit.
Name:
APPLICANT:
(If not the
owner,
authorization
required)
Company:
Address:
City:
State:
Phone-Home:
Work:
Fax:
Email:
Name:
OWNER:
(If different
from Applicant)
Zip:
Company:
Address:
City:
State:
Phone-Home:
Zip:
Work:
Fax:
Email:
Name or Type of Project:
Permanent Parcel Number
Location Address:
PROJECT:
Proposed Permitted Uses:
Proposed Accessory Uses:
Will project be completed in phases?
Yes
No
Current Zoning on Parcel(s):
Permit Type:
□ Accessory
Bldg.
□ New* (See Box Below) □ Alteration
□ Addition
□ Move
□ Home
□ Sign:
□ Change of Use:
Occupation
□ Fence
□ Other:
□ Satellite Dish
□ Temporary
□ Permanent
Use:
□ Residential:
# of Family
□ Commercial
Swimming Pool: □ Above-Ground
□ Below-Ground
□ Pole □ Other:
□ Industrial
□ Basement
□ Deck
# of Stories:
□ Crawl
□ Slab
□ Parking Lot
*FOR NEW DWELLINGS ONLY:
Usable floor space for use as living quarters EXCLUSIVE of basements, porches, garages, breezeways, terraces, attics, or partial stories.
First Floor:
REV Dec-14
sq. ft.
Second Floor:
sq. ft.
Total Sq. Ft:
Total # Bedrooms:
\Forms\Zoning\Application for Zoning Permit
IMPORTANT NOTICE TO APPLICANT: Any changes whatsoever concerning the information as shown in this
application such as Location, Size, Setback, Side yards, etc., must have approval of the Zoning Inspector. Failure in
this respect shall constitute sufficient ground for revocation of this permit.
Setback from R.O.W:
Property
Dimensions Main road frontage:
Depth of lot:
Buildings:
Project
Dimensions
ft.
From R.O.W. if Corner Lot:
ft.
Side yard setback:
ft.
ft.
Lot width at building setback:
Rear yard setback:
ft.
ft.
ft.
length:
Parking Lots:
Signs:
ft.
width:
Interior Lot:
length:
width:
length:
width:
sq. ft.
ft.
ft.
ft.
ft.
ft.
Highest point of construction:
Parking Space Dimensions:
Total Sign Square Footage:
length:
ft. (above established grade)
ft.
width:
ft.
sq. ft
Remarks and/or Special Instructions:
IMPORTANT: Zoning Inspector MUST be notified when footers have been poured. Phone 418-1120.
I have read the statements made herein and certify that they are true:
Applicant
Date
Company
A set of site and grading plans are required for all applications. Two (2) sets of site plans and two (2) complete sets of
building plans are required for applications involving construction projects. Plans must show all existing structures,
proposed construction or additional structures and indicate all dimensions, setbacks, lot line clearances, streets, and roads.
Date Footers Inspected:
□ Approved
□ Disapproved
Inspector:
Occupancy Permit Required:
Zoning Certificate:
□ Yes
□ No
Occupancy Permit #
□ Approved
□ Disapproved
If denied, reason for disapproval:
Zoning Inspector
RECEIPT:
$
Date
fee paid. Received by:
□ No Fee Agriculture
□ No Fee Non-Profit Organization
□ No Fee Church
REV Dec-14
\Forms\Zoning\Application for Zoning Permit