Fence/wall Land Use Application - East Manchester Township
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31/29/15 rev.
East Manchester Township
Tax Map #_____ Parcel #_____
FENCE/WALL 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: ________
For Front Yard Fencing Only: Width of Front Yard: __________ft Length of Front Yard: __________ft
OFFICE USE ONLY: Zoning: ________ Max Coverage: ________% = ________sq/ft of ________sq/ft lot size
Project Value: $__________________
IMPROVEMENT INFORMATION
Is your improvement a: Fence: _______ Retaining Wall: _______
(WALLS over 4ft in height needs UCC approval)
Type of fence/wall
(check all that
apply):
Decorative Metal: _____
Electric
_____
:
Wood:
_____
Farm Fencing:
_____
Retaining Wall Block
_____
:
Chain-Link:
_____
Garden Fencing: _____
Opaque:
_____
Chain-Mesh:
_____
Bamboo:
_____
Other
___________
(please describe):
Vinyl:
_____
Composite
_____
_____________________________
:
Max Height of Structure: ________ft Width: __________ft Length: __________ft Will this Enclose
_____
:
Location
Front Yard
_____ Rear Yard
_____ Side Yard
_____ Second Front Yard
_____
(check all that apply):
:
:
:
:
Proposed Use of Fence/ Wall: __________________________________________________________
(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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