DELAWARE
TOWNSHIP
DATE: ____________________________________
OWNER:_____________________________________________________
I _________________________________________________ do herby swear and affirm that the
addition/garage I am building to my home will not be serviced by water and will not add any
additional bedrooms to the residence.
Section ___________________________________________ Block _________________________________
Lot __________________ Subdivision __________________
WITNESS: ________________________________________________________
Print and sign name
WITNESS: ________________________________________________________
Print and sign name
REQUIRED AFFIDAVIT FOR BUILDING
IN MARCEL LAKE ESTATE
DURING MORITORIUM
BOARD OF SUPERVISORS 116 W ilson Hill Road • Dingmans Ferry, PA 18328
Phone: 570.828-2347 Fax: 570-828-8705 Email:dtbos@ptd.net
07092012
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