APPLICATION FOR SITE IMPROVEMENT PERMIT

CITY OF HUNTINGBURG

Permit No._______-_______

PROPERTY OWNER INFORMATION

Name________________________Address____________________Phone___________

APPLICANT INFORMATION

Name________________________Address____________________Phone___________

SITE AND CONSTRUCTION INFORMATION

Lot Number__________________________Street Address________________________

Present Use of the Land____________________________________________________

Proposed Use/Work to be Done______________________________________________

Estimated Start Date___________________Estimated Completion Date______________

A septic system permit is attached (see below) Yes No N/A

A driveway permit is attached (see below) Yes No N/A

COMPLETE THE SITE PLAN AND INFORMATION ATTACHED TO THIS FORM

SEPTIC PERMITS. If you are not connected to a municipal wastewater system, you will need a septic system construction permit for new or expanded use of a private wastewater management (septic) system. Call the Dubois County Sanitarian at 481-7055 for information.

DRIVEWAYS. If you are building a new driveway or widening an existing driveway, you may need another approval before submitting this application. Call:

If located on a state highway, whether inside or outside Huntingburg: Indiana Department of Transportation 812-937-4481

If located on a local street inside the City of Huntingburg: Huntingburg Street Superintendent 683-4122

If located on a county road outside the City of Huntingburg: Dubois County Highway Department 482-5505

UTILITY LOCATIONS. If you will be excavating, digging or moving dirt for your project, call 800-382-5544 to locate your utilities before submitting this application. This is a free service which will help you prevent building over damaging utilities. The following companies do not participate in this service, and you must call directly if they serve your land:

Dubois Rural Electric Cooperative 482-5454

Duff Water Corporation 536-3187 or 683-5464

St. Anthony Water Corporation 326-2512

St. Henry Water Corporation 367-2229

CITY OF HUNTINGBURG UTILITY CONNECTIONS AND SERVICES. For City of Huntingburg utility connections or services, call the following:

Utility connection costs and policies 683-2211(ask for utility office)

Water, electric and gas service 683-3622

Sanitary sewer service 683-3203

Streets and drainage 683-4122

OFFICE USE Zoning Classification_______________________ Floodplain Y N State/City/County Driveway Permit Y N N/R

Notes and Conditions of Approval:

Date Received___________By_________________________Date Issued_______________By__________________Fee: $________