Rental $25.00
Resale

Chesterfield Township
300 Bordentown-Chesterfield Road
Chesterfield, NJ  08515
(609) 298-0426

APPLICATION FOR CONTINUED CERTIFICATE OF OCCUPANCY

PROPERTY TO BE INSPECTED:
Address: 

Block:     Lot: 

OWNERS NAME: 

ADDRESS: 

PHONE: (daytime)  

Name of Buyer or New Tenant: 

Settlement or Lease Date: 

PERSON TO CONTACT FOR INSPECTIONS: 

DAYTIME PHONE: 

For Township Use Only:
 		 CERTIFICATIONS RECEIVED:  
Paid:  Check #_________     Cash:________
 		 HEATER
          		____________
INSPECTION DATE: __________________ HEATER CHIMNEY
 		 ____________
  FIREPLACE/WOODSTOVE
 		 ____________
  FIREPLACE CHIMNEY
 		 ____________
  WATER ____________