Property Owner:

Property Owner Address:

City:

State:

Zip:

Property Owner Phone:

Property Owner Email:

Applicant (If other than the owner):

Address:

City:

State:

Zip:

Daytime Phone:

Email:

Property Address:

Tax Parcel ID No.

Zoning District:

New Construction:

New Single-Family Dwelling

New Commercial Building

New Semi-Detached/Duplex

Porches/Deck — covered/uncovered (please circle)

New Townhouse

Echo D Dawdy

Alterations or Change of Use:

Addition to existing structure

Home Occupation- Must complete and attach Home Occupation Questionnaire

Change of Use — SpecifyChange of Use — Specify

OtherOther

Accessory Structures:

Brief Description of Project:

Total Cost of Project:

Lot & Building Information: All requested information must be completed.

Residential

Commercial

Agricultural

Industrial

Current use of the property:

Total Lot Area: (Sq. Ft.)

Corner Lot?

Yes

No

Proposed Building Size: (Sq. Ft.)

Proposed Height: Dimensions:

Existing Lot Coverage: (Sq. Ft.)

% of Lot Area

Proposed Lot Coverage: (sq. Ft.)

% of Lot Area

Proposed Setbacks: (Location of the proposed structure from the lot lines indicated in feet)

Additional Features:

Yes (Please provide copy of Deed if possible)

No

Are there any easements or deed restrictions on your property?

Are there any environmentally sensitive features located on the property (wetlands/swales/floodplain)?

Yes

No

For Changes To Existing Residential Structures:

Number Of Bedrooms In Structure:

Number Of Bedrooms In Proposed Structure:

Sewage Disposal System:

Public Sewer

On-Lot Septic

OtherOther

Water Supply:

Public Water

Well

OtherOther

Plot Plan:

A plot plan showing all existing improvements and proposed construction, including but not limited to: driveways, walkways, storm water management features, wells, easements, and utilities shall accompany this application. The plan shall include measurements of setbacks from all property lines and from the right-of-way of any road frontage on thc property. Adjoining propertiesshall be labeled. Until such plan is submitted, this application shall not be considered complete and will not be processed.
If the proposed is a Business, Industry, Home Occupation, or a Change of Use of a new or existing building, please enclose a detailed description outlining the products sold, manufacturing process, services rendered, equipment to be used, floor areas of building, number of employees, and any other infomation that is necessary to thoroughly describe the proposed operation.
Home Occupations — A narrative of the proposed home occupation and interior floor plan showing the location and dimensions of the space where the home occupation will be conducted must accompany the pen•nit application and plol plan. The narrative must address all the requirements set forth in the Zoning Ordinance.

Zoning Permit Checklist

All applicable information is included on the application in a legible form.
Attached a copy of the plot plan showing:
l. All existing buildings
2.	Location of the new improvement showing the distance from all property lines and distance between any new structure and other structures.
3.	Streets (public/private)
4.	Well, septic system; tank; drain field.
5.	Location of any easement or rights-of-way.
6.	Driveways and parking areas.

Attached copies of all other perrnits that may be required for the project. (i.e., on-lot septic,driveway, erosion, stormwater, land development, and sediment control plan)

Please Upload All Applicable Files

Maximum file size: 516MB

Signature:

I hereby authorize the designated Sadsbury Township official to investigate, inspect, and examine the Property set forth herein, including land and structures, to determine compliance with the Sadsbury Township Zoning Ordinance and tc determine the accuracy ofthe statements contained herein. I am aware that I cannot occupy the Property for the purpose of conducting the use set forth herein and cannot commence excavation or construction until a Zoning Permit has been issued by Associated Building Inspections.
A Zoning Permit may be revoked if the use and/or structure for which it has been issued violates any applicable Township, County, State or Federal law, or regulation, including but not limited to the Sadsbury Township Zoning Ordinance. This Permit may also be revoked if it has been issued in error, or if issuance was based upon any misrepresentations or errors contained in the application or otherwise made by the applicant. By signing this application, I certify that all facts in the application and all accompanying documentation are true and correct.
I acknowledge that the holder of a Zoning Permit is responsible to ensure compliance with all applicable Township Ordinances, and at completion of the work authorized by the permit, I acknowledge that the Township requires that a final inspection be performed by the Zoning Officer before the structure which is authorized by this permit may be occupied.

Printed Name:

Signature: Owner

Clear

Date:

Applicant Printed Name:

Signature: (Applicant, if not the owner)

Clear

Date:

The applicant is a worker within the meaning of Pennsylvania Workers' Compensation Act.

Yes

No

Applicant Name:

Federal or State Employer ID#:

Applicant is qualified Self-Insurer for Workers' Compensation:

Yes

No

Certificate Attached

Yes

No

Applicant's Workers' Compensation Insurer Name:

Workers Comp Policy #:

Policy Expiration Date:

If applicant is a contractor claiming exemption from providing Pennsylvania Workers' Compensation Insurance. The undersigned swears or affirms that he/she is not required to provide Pennsylvania Workers' Compensation Insurance coverage under the provisions of the Pennsylvania Workers' Compensation Act for one of the following reasons:

Contractor with no employees (contractor is prohibited by law from employing any Individual to perform work pursuant to this permit).

Religious Exemption under Pennsylvania Workers' Compensation Act.

Applicant Signature:

Clear

Date:

Date Received:

Date Approved:

Impervious Coverage Worksheet:

In accordance with the Sadsbury Township Ordinance, all new construction and remodeling projects must meet the requirements of the applicable Building and Maximum Impervious Lot Coverage percentage as described in the applicable district within the ordinance.
BUILDING COVERAGE: The aggregate of the maximum horizontal cross-section areas of all the buildings on a lot. Including porches, breezeways and carports. Excluding: cornices, eaves, gutters, chimneys (projecting not more than 18"), bay windows (not extending through more than one story & not projecting more than 5'), uncovered steps and balconies.

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Other Impervious Coverage: Material which is or is likely to become impervious to stormwater infiltration. Including but not limited to; buildings, structures, paved or graveled areas, driveways, parking lots, sidewalks, terraces, patios, swimming pools, tennis courts etc. All measurements need to be in Square Feet (SF).

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