Application for New Residential Permit

Application checklist

No packet can be accepted with items missing.

Application must be completely filled out (no blank spaces).

Copies of approved well and septic permits from the Fairfield County Health Department.Fairfield Department of Health · 1587 Granville Pike, Lancaster, OH 43130 · 740-652-2800

Signed “Notice About Fairfield Department of Health Plumbing Permits” form (below) — must be marked “yes” or “no.”

Actual street address of property, in letter form, from the Fairfield County Engineer’s Office.Fairfield County Engineer’s Office · 3026 West Fair Avenue, Lancaster, OH 43130-8993 · 740-652-2300

Site plan drawn to scale showing actual dimensions and shape of lot, location of proposed and existing buildings, and driveway plan. Indicate how many feet structures will be from all property lines. May be drawn on legal survey paper.

Legal description of property (ask the office for assistance if needed).

Driveway / culvert / right-of-way application, if the house is to be built on a township road. Open that form.

One (1) set of architectural drawings not to exceed 11 × 17 in size.

New residential fee: up to 3,000 sq. ft. — $1,200; over 3,000 sq. ft. — $1,500.

All applications must be signed by the property owner (not the builder). The only exception is if the applicant has power of attorney. Fill in your details on screen, then print and sign in ink — signatures must be original, not faxed, copied, or electronic. Make checks payable to Bloom Township.

Application for New Residential Permit

Per Bloom Township Zoning Resolution 412–414, all permits are conditioned upon commencement of work within one year of filing. If work is not completed within 2 years of issuance, the permit shall expire.

Property owner name(s) (required)

Property address where permit is to be issued (required)

Current mailing address

Property owner phone number

Parcel #

Builder’s name / phone number

Size of lotacres

Road frontage at building line (50′ from right of way)feet

Front yard depth (edge of right of way to front of house)feet

Rear yard depth (rear of house to rear property line)feet

Right side width (side of house to right property line)feet

Left side width (side of house to left property line)feet

Total square footage of living space (excluding garages, basement, and unheated areas)sq. ft.

Approximate total value of land and house upon completion (for Bloom Township statistical purposes only — not for taxation)$

Please note: all spaces above must be completely filled in to avoid denial of the application.

Notice about Fairfield Department of Health plumbing permits

The Fairfield Department of Health requires any new structure to have a plumbing permit if plumbing is being added to the structure. In a collaborative effort, the Bloom Township Zoning Department provides this document to the Fairfield Health Department regarding all new construction in the township to obtain the necessary permits, if applicable. Call (740) 652-2800 to speak with a Department of Health representative. This form must be submitted and marked “yes” or “no.”

Plumbing notice

Property location

Type of constructionFor example: new residence, residential addition, outbuilding, etc.

I will install new plumbing with my new structure (required)

YesNo

Phone number

Applicant

Date

Examples to follow: the original packet PDF includes example documents — a valid “to scale” site plan, and example well/septic and county address-letter documents. View them in the original PDF packet.

Application for New Residential Permit

Application checklist

Setback requirements for a new residence

Application for New Residential Permit

Notice about Fairfield Department of Health plumbing permits