Application for Zoning CertificateOhio Revised Code Section 519.16

Submittal Requirements:

• Legal description of the property, to obtain call Pickaway County Auditor at 740-474-5826 Pickaway County Recorder or see http://pickaway.iviewauditor.com (opens in a new tab);
• Detailed drawing to scale indicating the property lines, streets, and proposed or existing structures;
• Approval letter from Pickaway County Health Department for structures with a permanent foundation;
• Authorization for Owner's Representative completed and notarized if applicant is not property owner;
• Supporting documentation as required by Zoning Inspector to support conformance and enforcement of the Zoning Resolution;
• Application filing fee payable to Circleville Township (refer to adopted fee schedule); and
• Three (3) copies of all submitted materials in addition to the original.

Applicants are required to comply with all County Building Department regulations following approved zoning certification application.

Owner/Applicant Information:

NOTE: All property owners must sign the application; if more than two owners, attach additional information to application.

Subject Property:

Project Information, Type of Work (provide details on Page 2):

Type of work

New Building:Residence(forliving units)Accessory BuildingCommercial Building

Type of work, continued

AdditionPondPool with fence (if required)FenceOther

Pool Information

Pool type

Above GroundInground

Structure Information

Rev. 08/22Page 1

Off Street Parking and Loading

Proposed Setbacks for Project inclusive of driveway

Pickaway County Health Department

Water-County Health Department has approved:

city water, ordeep well.

Sanitary Waste- County Health Department has approved:

Conventional leach bedCity Sewer, or Other

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. The applicant further agrees to conform with all zoning regulations in place on the date of the application for the area represented. The Zoning Certificate shall expire and shall be revoked if work has not begun within one hundred eighty (180) days, and substantially completed within eighteen (18 months)

Rev. 08/22Page 2