(Execute in Duplicate) Application No. __________________________
Office of the Mayor Application No. __________________________
Village Hall
Argenta, Illinois DATE: ________________________, _______
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(DO NOT WRITE IN THIS SPACE - FOR OFFICE USE ONLY)
DATE: ____________________, ____ PERM. PARCEL _____ _____ _____ _____ ______
[ ] Permit Issued Fee Paid to Village Clerk:
[ ] Permit Denied
[ ] Application Appealed $ ____________ DATE: ____________, _______
IF DENIED, CAUSE OF DENIAL:
__________________________________________________
__________________________________________________
__________________________________________________
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INSTRUCTIONS TO APPLICANT: All information required by the application must be completed and submitted herewith. Applicants are encouraged to visit the Village Hall for any assistance needed in completing this form.
1. Name of Owner(s): ______________________________________________________________
(Attach additional sheets if necessary)
Address: _________________________________ PHONE: ________________________
(ZIP CODE)
2. Applicant's Name: _________________________ PHONE: ________________________
Address: _________________________________
(ZIP CODE)
3. Property interest of applicant: ____________________________________________________
(Contract Purchaser, Etc.)
4. Address of proposed construction or mobile home: ___________________________________
5. Legal Description (Lot, Block, and Subdivision; attach metes and bounds description, if necessary).
___________________________________________________________________________________ _____________________________________________________________________________________
Cost of Improvement: $ _____________ Square feet of Improvement _________________
6. Proposed construction (check one or more, as necessary):
[ ] New Building Type: __________ Brick/Frame Number of Rooms ______________
[ ] Alterations or additions to existing buildings (explain): ____________________________________
_____________________________________________________________________________________
7. Use of existing and proposed structures (if applicable):
Existing Use: ________________________________________________________________________
Proposed Use: ________________________________________________________________________
8. Two copies of a sketch plat (drawn to approximate scale shall be attached, showing the following:
a) Dimensions and use of all buildings;
b) Dimensions of lot;
c) Distance of each building from lot lines;
d) Distance of principal building from principal buildings on adjacent lot(s);
e) Distance between accessory buildings and principal buildings;
f) Distance from lot line to center line of abutting street(s);
g) Location [with dimensions] of driveways and off-street parking spaces;
h) Location of all easements;
i) Location of all underground utilities, including septic tanks, tile fields and wells.
9. Application is hereby made for an occupancy permit as required under the Village Code for the erection, moving or alteration and use of buildings and mobile homes. In making this application, the applicant represents all of the above statements and any attached maps and drawings to be a true description of the proposed new or altered uses and/or buildings. The applicant agrees that the permit applied for, if granted, is issued on the representations made herein and that any permit issued may be revoked without notice on any breach of representation or conditions. (See Chapter 151)
It is understood that any permit issued on this application will not grant right of privilege to erect any structure or to use any premises described for any purpose or in any manner prohibited by the Village Code, or by other ordinances, codes or regulations of the Village.
APPLICANT: _______________________________________
CERTIFICATE OF OCCUPANCY
The plans and specifications submitted with this Application are in conformity with the district requirements applicable to the subject property. Changes in plans or specifications shall not be made without written approval of the Village Board.
Failure to comply with the above shall constitute a violation of the provisions of the Revised Code of Ordinances of the Village.
DATE: _____________________________, _____ _________________________________
BUILDING OFFICIAL