BENSALEM TOWNSHIP
Building and Planning Department
Office 215-633-3644 ▪ Fax 215-633-3753
2400 Byberry Road ▪ Bensalem, PA 19020
Permit #
Date
Fee:
SUBMIT TO THE TOWNSHIP BUILDING & PLANNING DEPT AT 2400 BYBERRY RD OR EMAIL TO permitcenter@bensalempa.gov
Property Owner Information
NAME:
ADDRESS:
PHONE No.:
Applicant Information
NAME:
ADDRESS:
PHONE No.:
Site Information
Name of Plan:
Location:
Tax Parcel No. Parcel Size:
Zone Classification:
Proposed Use:
NOTE: Site plan showing extent of area to be cleared must accompany this form.
Signature
Owner Applicant
Date Signed
A SIGNED APPLICATION IS REQUIRED PRIOR TO ISSUANCE OF PERMIT
APPROVED:
YES NO
You are hereby issued a permit for site preparation at the site identified above.
This permit is for clearing and rough grading only.
A land alteration permit must be obtained prior to the installation of any site improvements.
Township Engineer Signature Date
Comments:
SITE PREPARATION APPROVAL
PPLICATON
