CHARTER TOWNSHIP OF CLINTON
RESIDENTIAL RENTAL PROPERTY
APPLICATION
Receipt No. _______________________ Inspection Date _________________
Date Received________________________ Rental Permit # ____________________
Rental Property Address ______________________________________________________
Building # _________________ Number of Rental Units Per Building ________________
Type of Rental Units: Single Family
Two Family
Multi-Family
Boarding House
Hotel
Rooming House
Lodging House
Tourist Home
Dormitory
Other
Occupant Name __________________________
Phone No. ____________________
Property Owner
Print Name
_______________________________________________________________
Address
_______________________________________________________________
City
____________________________ State _________ Zip Code __________
Home Phone No. ________________
Office Phone No. ___________________
Date of Birth or
Driver’s License No. ____________________ Signature: __________________________
Property Manager (if applicable)
Print Name
_______________________________________________________________
Address
_______________________________________________________________
City
____________________________ State _________ Zip Code __________
Home Phone No. ________________
Office Phone No. ___________________
Driver’s License No. ____________________ Signature: __________________________
Authorized Representative (Repairs or Service)
Print Name
_______________________________________________________________
Address
_______________________________________________________________
City
____________________________ State _________ Zip Code __________
Home Phone No. ________________
Office Phone No. ___________