Germantown: OWNER CONSENT FORM

TOWN OF GERMANTOWN
50 Palatine Park Road
Germantown, NY 12526

Phone: (518) 537-6687 Fax: (518) 537-6001
Visit us on the web: www.germantownny.org Email us at: gtownny@valstar.net
APPLICATION: OWNER CONSENT FORM
Date of Application

MonthDayYear
Date
OWNERS OF PROPERTY
Owner of Property

First NameLast Name
Tax Map Number
Address of Property

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Applicant
Description of Work to Be Done:
I/We
Enter owner's names here.
Owner(s)of the above land/building hereby give my/our permission to:
Enter applicant name below:
to submit the above identified application on my/our behalf and to represent me/us in all proceedings before the Town of Germantown Building Department/Planning Board and/or Zoning Board of appeals.
Owner's Signature

Clear
Date

MonthDayYear
Date
Additional Owner's Signature (if needed)

Clear
Date

MonthDayYear
Date
Should be Empty:

APPLICATION: OWNER CONSENT FORM