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Town of Montville
Building Department
848-3030, Ext 82
ONE &TWO FAMILY
CERTIFICATE OF OCCUPANCY
SIGN-OFF SHEET
Aar
Property Ad. ess
Job Description:
The owner/agent shall be responsible for the completion of the form, no certificate of occupancy will be issued
signatures below have been obtained. until all
HEALTH DISTRICT
848-3030-882
Approved
Septic System 0 Permit#: Not Applicable
Date
Approved
Private Well ❑ Permit#: a Not Applicable
WPCA DEPARTMENT Date
848-3030 Ext 881
Approved
Municipal Sewer 0 Permit#: ❑ Not Applicable
Date
Approved
Munici.al Water
0 Permit# ❑ Not Applicable
DEPARTMENT OF PUBLIC WORKS Date
848-7473
Approved �r
Director ❑ Permit#: G4Not Applicable
PLANNING&ZONING DEPARTMENT Date
848-3030 Ext.81
r _ In-Compliance
G 15Z- Permit#: O t
Zoning Date '�UZ ` 7 0 Not Applicable
In-Compliance
Inland-Wetlands , ❑ Permit#:
Date ® Not Applicable
Town of Montville
Building Department
Date 5 /Z3/ OZ- Field Inspection Notice Permit #
Job Location 11 PA-112-1 t G0 / ioUaW
Approved Type of Inspection S oD G/v
Not Approved - Please call for re-inspection when the following corrections have been completed:
1
Building Official