P. O. Box 1746 Covington LA. 70434

Project Approval From

Project___________________________________________________________________________________

Date Submitted_____________________________________         

Name______________________________________________________________________________

Address___________________________________________________  Lot('s)#_____________________

Home Phone______________________________   Cell_________________________________________

Email Address_____________________________________

Plans Submitted      Yes    No

Explanation of Project (can use back if no plans submitted)

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Accepted... Date___________________________  Rejected...Date___________________________ 

Reason if rejected:______________________________________________________________________

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Signature of Board Member_____________________________________________________________