Fillable Print Zoning Permit Form (City of St. Marys)

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Print Zoning Permit Form (City of St. Marys)

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  • 18 check-boxes
  • 113 other fields

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[City of St. Marys Use Only]
Application Number: Date Received:
Zoning District: PERMIT FEE: $25.00
Tax Parcel ID#: [ ] CASH [ ] CHECK #
Subdivision: Lot#: RECEIPT #
Complete all applicable information. Be specific and descriptive. Do not omit important entries such as telephone numbers, Fed ID Numbers
etc. INCLUDING SIGNATURES.
[ Please Print ]
( If applicable )
Work Site Address: Agent:
Property Owner: Agent Address:
Mailing Address: City, ST, Zip:
City, ST, Zip: Agent Telephone:
Telephone: Agent Fax:
Email: Agent Email:
Architect / Engineer:
Address:
City, ST, Zip:
Telephone Number: Fax Number:
Email:
CERTIFICATION:
I hereby c
ertify that I am the owner of record of the named property, or that the proposed work is authorized by the owner of record, and that
I have been authorized by the owner to make this application as his/her authorized agent, and I agree to conform to all applicable laws of this
jurisdiction. In addition, if a permit for work described in this application is issued, I certify that the Code Official or his authorized
representative(s) shall have the authority to enter areas covered by such permit at any reasonable time to enforce the provisions of the code(s)
applicable to such permit.
X
Signature of Owner / Authorized Agent Date
\PermitApplications/20200211ZoningPermitApplicationFillable
Page 1 of 5
ZONING PERMIT APPLICATION
CODE ENFORCEMENT DEPARTMENT
11 Lafayette Street
Saint Marys, PA 15857
Phone (814) 781-1718 x227
www.stmaryspa.gov Fax (814) 834-1304
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signature
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BUILDING SECTION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
Type of Construction: Residential Use:
Type of Foundation: Commercial Use:
Size of Improvement: Industrial Use:
ZONING SECTION
Lot Width: feet Lot Depth: feet
Front Setback: feet Rear Setback: feet
Side Setback: feet Side Setback: feet
Number of Stories: Total Height: feet
I hereby certify that the information contained in this permit application is accurate to the best of my knowledge and any incorrect,
inaccurate, or omitted information, whether intentional or not, may result in the revocation of all or part of the permit approval, and is
considered a violation of the City of St. Marys Zoning Ordinance of 2005 and may result in paying a judgment of $500, plus all court costs
and reasonable attorneys fees incurred by the City as a result thereof. I also hereby certify that I am the owner of record or the agent of the
owner of record, and am authorized to make this application.
X
(Signature Owner / Authorized Agent)
\PermitApplications/20200211ZoningPermitApplicationFillable Page 2 of 5
Description of Work:
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signature
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City of St. Marys Use Only (Entire Page)
RECOMMENDATION OF ZONING OFFICER
Zoning Application: [ ] Approved [ ] Denied (cite specific section of Zoning Ordinance):
Appealed and referred to the Zoning Hearing Board for:
[ ] Variance [ ] Special Exception [ ] Interpretation
Fee: [ ] Cash [ ] Check # Receipt #
Fee Received By: Date:
Zoning Officer: Date:
ACTION TAKEN BY ZONING HEARING BOARD
[ ] Variance Granted [ ] Special Exception Granted [ ] Application Denied [ ] Application Misinterpreted
According to Section(s)
of the City of St. Marys Zoning Ordinance of 2005.
Zoning Hearing Board Chairperson: Date:
ACTION TAKEN BY CITY COUNCIL
Conditional Use Zoning Application: [ ] Approved [ ] Denied
City Council: Date:
Mayor
Attest: Date:
Secretary
\PermitApplications/20200211ZoningPermitApplicationFillable Page 3 of 5
City of St. Marys
Small Project Stormwater Management Application
The Stormwater Management Ordinance requires a Small Project Stormwater Management Application be submitted whenever
more than 1,000 square feet of impervious surface is proposed.
Impervious surfaces are areas that prevent the infiltration of water into the ground and shall include, but not be limited to roofs,
patios, garages, storage sheds, streets, sidewalks, driveways, and parking areas.
Table F-1
To Calculate Impervious Surfaces Please Complete This Table
Surface Type
Length
X
=
Proposed Surface Area
Building
Driveway
Parking Areas
Patios/Walks
Other
Total Impervious Surface Area Proposed (Sum of All Areas)
NOTE: The City of St. Marys can require the applicant to provide supplemental and additional information beyond the Small
Project SWM Application if there is a threat to property, health or safety.
Property Owner should consult Section 202 of Chapter 26 of the St. Marys City Code Book for additional information on
compliance requirements.
Property Owner Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner or the owner’s legal representative. I further
acknowledge that the information provided is accurate and City employees are granted access to the above-described property
for review and inspection as may be required. Further, I declare the issuance of a permit, waiver, or exemption by the City of St.
Marys in no way relieves me from complying with State Water Quality Standards or actions posing a threat to property, health or
safety. The City of St. Marys assumes no responsibility for the implementation, proper construction, or future compliance with
Chapter 26.
(Print Name)
: Owner Date:
(Signature)
\PermitApplications/20200211ZoningPermitApplicationFillable Page 4 of 5
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REGULAR LOT
REAR
FRONT
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Completed 16 July 2020

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