APPLICATION FOR
SITE IMPROVEMENT PERMIT
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: $________
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