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Application for Zoning Certificate

Fill in the application below, print it, add your lot sketch and signature, and submit it to the Zoning Inspector.

APPLICATION FOR ZONING CERTIFICATE

Form Z1-1 (To Zoning Inspector) (R.C. 519.16)

Application No.

Jersey Township, Licking County to the Board of Township Trustees.

The Undersigned hereby applies for a Zoning Certificate for the following use, to be issued on the basis of the Representations contained herein, all of which applicant swears to be true.

  4. Proposed use:
    sq.ft.
  5. Is this application for a “Temporary Visitors” Certificate?
  6. Is this application for a “Temporary Residence” permit?

  7. Sketch a lot, showing existing buildings and proposed construction or use for which this application is made. (See Reverse Side). Fill in all directions and indicate which direction is North with an arrow.

    1. ft.
    2. ft.
    3. ft.
      ft.
    4. ft.
    5. ft.
    6. ft.
      ft.
    7. ft.
    8. ft.
    9. sq.ft.

  8. Buildings Use:

    sq.ft.

    Usable floor space designed for use as living quarters exclusive of basements, porches, garages, breezeways, terraces, attics, or partial stories.

    sq.ft.
    sq.ft.
    sq.ft.
    sq.ft.
  9. Have you a “Sewage Disposal Permit” from the Licking County Health Department?
  10. Will you have your own private well or water supply?
Applicant

County Permits Required:

Licking County Health Department

NOTE: This permit expires 18 months after date of application. NOT TRANSFERABLE

Inspector
(Approved) or (Denied) on

This property ( is, is not ) in an identified Flood Plain.

Sketch See No. 7

North
Original PDF

Information typed on this page stays on your device. Nothing is sent to the township. The printout includes a blank page for the lot sketch (No. 7).