►Application not valid unless Signed◄ Rev 8-2-19 seh
Borough of Gettysburg
59 East High Street
Gettysburg, PA 17325
LAND USE PERMIT APPLICATION
REQUIRED: A plot plan showing dimensions of the lot, buildings, sidewalks, driveways for any additional
coverage/structure. Signs must show placement on structure/sidewalk/property. Permit Fee: $36.00
Address of Property: Zoning District: Lot Size:
APPLICANT Name Phone Cell
APPLICANT Complete Address APPLICANT Email
OWNER Name Phone Cell
OWNER Complete Address – if other than Site Address OWNER Email
CONTRACTOR Name Phone Cell
CONTRACTOR Complete Address CONTRACTOR Email
PA Contractor License #: COST OF IMPROVEMENTS(s) including labor:
Please provide an accurate & complete description of the proposed project:
Use additional sheets if necessary and drawings if they will assist in the explanation
I certify that I am the owner of record, or that I have been authorized by the owner of record to submit this application and that the work described has
been authorized by the owner of record.
Application must be signed:
APPLICANT SIGNATURE DATE
►Below is for Official Use ONLY◄
Type Of Improvement Proposed Use / Residential Proposed Use / Commercial PERMITS REQUIRED
[ ] New Building [ ] Single Family [ ] 3 or more residential units
[ ] Addition [ ] Two-Family [ ] New Business
[ ] Alteration [ ] Garage/Carport [ ] Change of Use [ ] ZONING
[ ] Repair, Replacement [ ] Deck/Porch [ ] Sign(s)
[ ] Demolition [ ] Swimming Pool [ ] Other (specify) [ ] LAND DEVELOPMENT
[ ] Roof [ ] Storage Shed
[ ] Fence [ ] Home Office [ ] NON-UCC (BLD)
[ ] Other (Specify) [ ] Other (Specify)
Permit: # Expiration Date: Cert. of Liability provided N/A
Approved: Date: Payment ($36) Received
