DELAWARE
TOWNSHIP
I _________________________________________________ am the legal owner of property identified as
Section ________________Block __________________ Lot ________________Subdivision ____________
and I grant permission for agents and employees of Delaware Township to enter my property for
sewage testing and permitting purposes.
Signed: __________________________________________________________________________________
Dated ____________________________________
BOARD OF SUPERVISORS 116 W ilson Hill Road Dingmans Ferry. PA 18328
Phone: 570.828-2347 Fax: 570-828-8705 Email:dtbos@ptd.net
BOARD OF SUPERVISORS
TRESPASS WAIVER
07092012
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