Barton Town Clerk's Office

Town of Barton

A.D. Received For

Application for Certificate of Occupancy

Record at

mid Recorded in Book.

This form must be complete

Minutes

o'clock

M

_Page(s)_

Of the Town of Barton Land Records

Zoning Permit No.: Town Clerk

Attest

Effective Date:

Date Project Completed:

Date of C of 0 Application:.

Physical Location of Property:

Name of Applicant (if other than landowner):. __Telephone:_

Address: Name of Landowner:

.Telephone:

Address:

This permit certifies that the building or use at the above location conforms to the approved plans here tofore filed with the Administrative Office, and with all applicable provisions oftheBarton Town Zon

ing Regulations. No construction may be commenced or change ofuse made in any building oron any premise which is inconsistent with this permit. Signature of Applicant/Owner: Printed Name of Applicant/Owner:_ Date of Inspection:

Granted:

Administrative Officer

Date Received

Fee Paid $

Denied:

Date

Initials: