Accessory Structure Land Use Application - East Manchester Township
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39/25/14 rev.
East Manchester Township
Tax Map #_____ Parcel #_____
ACCESSORY STRUCTURE LAND USE APPLICATION
Application Date:
_________________________
Applicant Name: _________________________________________________Telephone #: ________________
Address: ___________________________________________________________________________________
PROPERTY OWNER INFORMATION - (if different than applicant)
Name(s): ______________________________________________________Telephone #: __________________
Address: ___________________________________________________________________________________
PROPERTY INFORMATION
Address Work is Occurring At: _________________________________________________________________
Special Exception/Variance Granted: No Yes
_____________________________________________
(describe)
Lot Size: ________ Corner Lot? ________ Flood Zone? ________
(if yes, submit details including engineer's drawing)
Right-Of-Ways or Easements? ________ Is your property: Residential: ________ Non-Residential: ________
OFFICE USE ONLY: Zone: ________ Max Coverage: ________% = ________sq/ft of ________sq/ft lot size
TOTAL EXISTING IMPERVIOUS SURFACE
Primary Structure:
________sq/ft
Existing Patio(s): ________sq/ft
Garage(s):
________sq/ft
Existing Pool:
________sq/ft
Existing Shed(s):
________sq/ft
Other:
________sq/ft
Existing Driveway(s): ________sq/ft
Other:
________sq/ft
Existing Deck(s):
________sq/ft
TOTAL:
_____________SQ/FT
Project Value: $__________________
IMPROVEMENT INFORMATION
Type of Accessory Structure: Shed:_____ Pole Building: _____ Deck: _____ Patio: _____ (pavers, cement,
other) Awning: _____ Porch: _____ Stairs: _____ Carport
_____
(two or more sides exposed):
Garage: _____ Other
______________________________________________________________
(please describe):
Maximum Height of Structure: ________ft
Foot print of structure: ________sq/ft
The Accessory Structure will be
Attached: ________
Unattached: ________
:
Proposed Use of Accessory Structure: __________________________________________________________
(if the owner or applicant is the contractor, just write “self”)
CONTRACTOR/BUILDER INFORMATION
Name: _____________________________________________________________________________________
Address: _______________________________________________________Telephone #: ________________
Person in charge of work: _________________________________________Telephone #: ________________
Note: An updated Certificate of Insurance must be on file with East Manchester Twp.
Workers Compensation Company and Policy#: __________________________________ Expiration: ______
Liability Company and Policy#: _______________________________________________ Expiration: ______
Agent: ________________________________________________
Phone Number: _____________________
Address: ___________________________________________________________________________________
717-846-2004
Inspection Agency:
Commonwealth Code Inspection Service, Inc.
The applicant hereby makes request for a permit under all applicable Codes of the Township of East Manchester and hereby
certifies, under the penalties of perjury, that all facts set forth above are true and correct and the actual work will be performed in
accordance with the above. All applicable construction must meet Code as defined within Act 45 - PA Construction Code
____________________________________________
Owner or Owner Agent's Signature
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