P.O. Box 203 Long Pond PA 18334
(570) 646-3008 FAX: (570) 643-5469
The Zoning Office will approve or deny all permit applications
within 30 days of receipt.
DESCRIPTION OF PROPOSED WORK CONSTRUCTION INFORMATION
_____________________________________________ CONTRACTOR: ______________________________________
_____________________________________________ ADDRESS: __________________________________________
Residential _____ Commercial _____ ___________________________________________________
Primary _____ Vacation _____ CITY & STATE: _______________________________________
ZIP: ________________ PHONE: ________________________
PROPERTY OWNER: ________________________________ IMPROVEMENT SIZE SQUARE FEET __________________
MAILING ADDRESS _________________________________ HEIGHT __________ # OF STORIES _____________
____________________________________________________ CIRCLE FOUNDATION TYPE:
Basement Crawl-Space Slab Pier Other
CITY & STATE: ______________________________________
ZIP: ________________ PHONE: _______________________ # OF BEDROOMS ________ # OF BATHS __________
APPLICANT: Property Owner Contractor # OF FIREPLACES ________ #OF FAMILIES ________
OTHER: _____________________________________________ HEATING SYSTEM ______________________________
ADDRESS: __________________________________________ MOBILE HOME YEAR __________________________
____________________________________________________ OFF STREET PARKING SPACES _________________
CITY & STATE: _____________________________________ SEWAGE PERMIT # ____________________________
ZIP: _______________ PHONE: ________________________ CONSTRUCTION COST: ________________________
PROPERTY TAX ID: 20/______________________________ ADDITIONAL INFORMATION: ___________________
PIN NUMBER 20____________________________________ ________________________________________________
DEVELOPMENT NAME: _____________________________ APPLICANT SIGNATURE: ________________________
LOT/SEC: _______________ ACREAGE: ________________ DATE:___________________________
ROAD NAME: _____________________ TOWNSHIP: Y N OFFICE USE:
DEED: ____________________DEED DATE: ____________ APPLICATION NUMBER: ___________________
ZONING: R1 R2 C1 C2 OSW I DATE: ___________________________
ADJOINING LOTS: Residential Commercial AMOUNT RECEIVED: _______________ CHECK # ___________
WETLAND: Yes No FLOOD PLAIN: Yes No RECEIVED BY: ___________