BENSALEM TOWNSHIP
Building and Planning Department
2400 Byberry Road Bensalem, PA 19020
Office 215-633-3644 Fax 215-633-3753
Application for Alteration of Land Permit
10/2015
SUBMIT TO THE TOWNSHIP BUILDING & PLANNING DEPT AT 2400 BYBERRY RD OR EMAIL TO permitcenter@bensalempa.gov
1. LOCATION OF PROJECT:
RESIDENTIAL COMMERCIAL
ADDRESS:
TAX PARCEL No.
2. APPLICANT INFORMATION
APPLICANT NAME:
CONTACT NAME: (if different from applicant)
EMAIL ADDRESS:
PHONE:
ADDRESS:
CITY:
STATE:
ZIP:
3. PROPERTY OWNER INFORMATION (if different from applicant)
PROPERTY OWNER:
EMAIL ADDRESS:
PHONE:
4. BRIEF PROJECT DESCRIPTION
5. IF APPLICABLE, DESCRIBE ANY WORK STARTED PRIOR TO RECEIVING PERMIT
6. REQUIRED QUESTIONS
Total area of property: Square feet
Total area of disturbance: Square feet
Additional impervious cover as a result of the project: Square feet
Total impervious cover: Square feet
Select plan type being submitted: Development
Filling of Property Excavation, Reclamation
(check all that apply)
Grading of Property Removal of Earth Stormwater Installation
Other (describe)
Is the project located in a floodplain? YES NO
Is there a stream or other wetlands located on the property? YES NO
How will drainage be affected?
Is this application part of an approved Land Development or Stormwater Management Plan? YES NO
A PLOT PLAN MUST BE SUBMITTED WITH THIS APPLICATION
1. Show all existing structures and setbacks.
2. Dimensions of the addition or proposed new structure and its location on the lot with all setbacks from property.
3. Include driveways, sidewalks, patios, etc. and their dimensions.
4. Plot plan should be drawn on regular, unlined paper, 8½” x 11”.
Signature of Applicant/Owner Date
Township Engineer’s Recommendation:
Permit No. _________________
Date: ________________
A SIGNED COPY OF THIS APPLICATION MUST BE SUBMITTED AT
THE TIME OF OR PRIOR TO ISSUANCE OF THE PERMIT
