SECAUCUS MUNICIPAL GOVERNMENT
PROPERTY MAINTENANCE
CERTIFICATE OF HABITABILITY APPLICATION
RESIDENTIAL COMPLEX
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ADDRESS
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UNIT LOCATION TO BE INSPECTED _____________ _
(UNIT MUST BEV ACANT, UNOCCUPIED WITH NO PERSONAL BELONGINGS)
EXPECTED DATE OF RE-OCCUPANCY
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CONTACT PERSON FOR ACCESS TO THE UNIT:
NAME
PHONE#
POSITION
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PLEASE CHECK ONE:
DFIRST INSPECTION (Fee $50.00)
Date Paid
Check#
DFIRST RE-INSPECTION (Fee $15.00)
Date Paid
Check#
Osecond or More Re-inspections (Fee $100.00)
Date Paid Check#
COMPLETED APPLICATION WITH A UNIT FLOORPALN MUST BE RECEIVED BY THIS OFFICE AT
LEAST THREE (3) BUSINESS DAYS PRIOR TO EXPECTED DATE OF REOCCUPANCY.
APPLICANT CERTIFIES THAT THE OWNER IS IN COMPLIANCE WITH:
CHAPTER 105 PROPERTY MAINTENANCE, INSPECTION OF CERTAIN DWELLING UNITS,
WITH RESPECT TO THE ABOVE UNIT
APPLICANT'S SIGNATURE
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signature
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