APPLICATION FOR LAND USE CERTIFICATE
Village of Dalton, Ohio
330-828-2221
Application #
(Village Use Only)
The undersigned applies for a Land Use Certificate for the use described, below. This Certificate will be issued on the basis of the information contained within this application. The applicant hereby certifies that the information and attachments to this application are true and correct. The applicant is required, in addition to the information requested on this form, to submit plans, showing the actual dimensions and shape of the applicant’s lot, exact sizes and locations of existing building on the lot, and the location and dimensions of the proposed buildings or alternations.
Location Description:
Subdivision Name:
Section: Township: Range:
Block:
(if not located in plotted subdivision, attach legal description)
Names of Owner:
Mailing Address:
Phone:
Existing List:
Proposed Use: New Construction: Business:
Remodeling: Industry:
Accessory Building: Sign: Size:
Residents: No. of Units: Other:
Type of Sewage Disposal: Village: Other:
Lot Width: Lot Depth: Other:
Square Feet of Living Area: Garage:
Basement: Accessory Building:
Office: Commercial:
Industrial:
Building Heights: Stories:
Yard Dimensions: Front: Rear: Side:
Commercial/Industrial
Accessory Building Dimensions: Height Side:
Number of Off-Street Parking Spaces to be provided:
Number of Off-Street Loading Berths to be provided:
On a separate sheet of paper, list other supplemental requirements or conditions that will be met, or explain any points that need clarification:
Note: The applicant must apply separately to the Wayne County Building Department for the appropriate building permits.
Submitted by: Date:
For Village Use Only
Received by:
Date:
Ordinance 9-15, Village of Dalton
(Ord. 9-15, passed 10-19-2015)