BUILDING PERMIT APPLICATION - Critical Area

PERMIT NUMBER
Town of Indian Head
4195 Indian Head Highway
DATE ISSUED
Indian Head, MD 20640
301 743-5511 ACCOUNT NUMBER
Building Permit Application
CRITICAL AREAS
BUILDING ADDRESS (HOUSE NO, STREET AREA) DESCRIPTION OF WORK;

SUBDIVISION

YARD DIMENSIONS
FRONT SIDES REAR
OWNER’S NAME AND ADDRESS PHONE NO.
BUILDING (INCLUDING GARAGE)
WIDTH DEPTH HEIGHT STORIES

OCCUPANT’S NAME PHONE NO.
FOUNDATION WALLS
TYPE OF MATERIAL
8” 12”

ARCHITECT/ENGINEER’S NAME AND ADDRESS PHONE NO. MAIN STRUCTURE FOOTINGS
TYPE OF MATERIAL SIZE

NO. ROOMS/UNITS PARKING SPACES BASEMENT
CONTRACTOR’S NAME AND ADDRESS PHONE NO.
Y N

UTILITIES
WATER SEWER ELECTRICITY
MHBR # OR MHIC# EXP
INTENDED USE OF STRUCTURE (BE SPECIFIC) I have carefully examined and read the above application and know
the same is true and correct, and that in doing this work, all
provisions of the Code of Ordinances, and Laws of the State will be
complied with, whether herein specified or not.
ESTIMATED CONSTRUCTION COST
______________________________________ ________________
SIGNATURE DATE
PERMIT FEE PLAN REVIEW FEES
CONDITIONS (IF ANY);
*ALL PROJECTS MUST HAVE CCSCD’s WRITTEN APPROVAL FOR OFFICE USE ONLY
PRIOR TO ANY PERMITS BEING ISSUED AND;
IN ORDER TO MEET IMPERVIOUS SURFACE REQUIREMENTS, WE DATE APPROVED DENIED
ARE REQUIRING THAT THE FOLLOWING CONDITIONS BE MET FOR
DECKS BUILT IN THE CRITICAL AREA DISTRICT OF INDIAN HEAD; ZONING
1). THE FLOOR BOARDS MUST BE SPACED AT LEAST ¼” APART,
TOWN MANAGER
2). THE GROUND DIRECTLY BENEATH THE DECK MUST HAVE A
6” BED OF GRAVEL (NO PAVING OR PAVERS)

3). THE GRAVELED AREA MUST BE RIMMED WITH SHRUBS, BUT UTILITY CONNECTIONS DATE INSPECTED APPROVED DENIED
CAN ALLOW FOR A WALKWAY SPACE FROM A GROUND
LEVEL DOOR.
INSPECTED BY
CC SOIL CONSERVATION DISTRICT- PHONE: 301 638-3028

To begin construction before a building permit has been issued is a violation of law.
Work shall not proceed until the Inspector has approved the various stages of construction.
ALL PERMITS SHALL EXPIRE SIX MONTHS AFTER DATE OF ISSUE