CITY OF ROSSFORD, OHIO
ZONING APPLICATION

Permit No: _____________              Non-Refundable Fee: $50.00         Late Fee:__________________

Resident/Owner: ____________________________________________ Telephone:_________________

Address: __________________________________________________ Zip Code:__________________

Contractor: ________________________________________________ Telephone:_________________

Address: __________________________________________________ Zip Code:__________________

Located on the:   N   S   E    W   side of ___________________________________________, between

_____________________________________and____________________________________________

Proposed Use:________________________________________________________________________

Site Address: ___________________________________ Zoning District:________________________

Legal Description:_____________________________________________________________________

ROSSFORD MUNICIPAL CODE REQUIRES ALL CONTRACTORS WORKING WITHIN THE CITY TO BE LICENSED. Please list below the names, address and telephone numbers of the sub-contractors involved in this project.

I HEREBY DECLARE THAT ALL ABOVE AND ATTACHED INFORMATION IS CORRECT.

Signed: _____________________________________Date:_____________________________________

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OFFICE USE ONLY

Sanitary Sewer No:_____________________________________ Storm Sewer No:_________________

Water Tap No: ________ District I ________ JEDZ District _________Record No:__________________

Variance Needed: _________Variance Granted:     Yes    No     Date:____________________________

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Zoning Inspector: _______________________________Date:_______________    Approved     Denied

Comments:___________________________________________________________________________

City Administrator: ______________________________Date: _______________  Approved     Denied

NOTICE

YOU ARE APPROVED TO DO ONLY THE WORK ACCORDING TO THE DRAWINGS, PRINTS,

AND/OR SPECIFICATIONS SUBMITTED ON ____________________ No. __________________.  IF

ANY ALTERATIONS ARE MADE TO THE DRAWINGS OR SPECIFICATIONS OR ANY CHANGE

MADE TO THE PROJECT THAT WAS APPROVED, IT COULD RESULT IN AN ORDER TO TEAR

DOWN THE STRUCTURE AND REBUILD IT ACCORDING TO THE APPROVED PLAN.

NOTE: PERMITS ARE ONLY GOOD FOR ONE YEAR FROM DATE OF ISSUANCE.

I hereby state that all the plans submitted are true and accurate.

Signature: _______________________________________________Date: _______________