SELLER OR OWNER
NAME:	____________________________________________________________________
ADDRESS:	____________________________________________________________________
CITY:	___________________	STATE:________	__________
TELEPHONE NUMBER:___________________________
Seller realtor:	________________________________________		Realtor's #		_________________________
PROPERTY LOCATION: _________________________
	BLOCK:______________Lot_____________
NAME OF BUYER OR TENANT		________________________________________________
TELEPHONE NUMBER:		________________________________________________
Byr. Realtor:	______________________________		Realtor's #		_________________________
NAME AND DATE OF BIRTH OF SCHOOL AGE OCCUPANTS  :
NAME:	_____________________________________			DATE OF BIRTH		______________
NAME:	_____________________________________			DATE OF BIRTH		______________
NAME:	_____________________________________			DATE OF BIRTH		______________
NAME:	_____________________________________			DATE OF BIRTH		______________
NAME:	_____________________________________			DATE OF BIRTH		______________
TYPE OF INSPECTION REQUESTED
___________	ANNUAL RENTAL LICENSING (APT/CONDO/HOUSE)
___________	RESALE INSPECTION
___________	RENTAL/RESALE  RE-INSPECTION
LANDLORD / RENTAL MANAGER
DATE TENANT VACATED PREMISES OR DATE OF SETTLEMENT					_________________________
PLEASE FAX TO (609) 877-2308 IMMEDIATELY UPON VACANCY OF ABOVE TENANT.
TOWNSHIP OFFICIAL
DATE SUBMITTED		___________		REINSPECTION
INSPECTION DATE		___________		___________
INSPECTION TIME		___________		___________
CHECK/RECEIPT #		___________		___________
Please schedule inspections no more than 30 days before and
at least two weeks before settlement or occupancy.

Township of Edgewater Park

Certificate of Occupancy Application

400 Delanco Road

Edgewater Park, NJ 08010

Phone 609-877-2062                                                                      Fax 609-877-2308