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t <br /> .4 <br /> Town of Mashnee <br /> Application for Permit to Perform Memorial Work in Cemeter <br /> This gpplication must be submitted r �itfi nint � ', hours prl'01' 10 117 11" 11 01' e JJ� <br /> ----- -- -----.. g <br /> perLormed <br /> Date <br /> Cem t [ <br /> Section: 'lot No. <br /> Plot owner_ <br /> -Individual/CompanyPerformin Word : <br /> Telephone No.: Fax No. <br /> License No.: <br /> Insurance Company: Policy o.: <br /> Please pr6vide cQak oLinsuroncepolicy r 'n t alreadv on le with the <br /> Type of Memorial. 0 Flush Marker 0 Monument <br /> Size of Memo r' .1 Ire inches. List base r tel if monument <br /> Flush Marker Monument <br /> width: Len h: Base: Width- Length' <br /> Headstone: Width: Length <br /> Date ofProposed Work: <br /> Signature of Applicant: <br /> For Office Use <br /> Date Permit Issued: 'Permit 'No., <br /> Date Plot Marked-... - - - - - - Date of Final Inspection: -Remarks: __- <br />