HomeMy WebLinkAboutBLDTR-19-003566 F' 4'0 'Y R,. TOWN OF YARMOUTH
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BUILDING DEPARTMENT Permit Nu[i[bet� 72" �9"� 3
• n; . ,i it y 1146 Rotate 28. South Yarmouth. MA 02664
../. `v� ;, 'r. Sos-398-2231 ext.I261 Fax 508-398-0836 Date Issued
' Expiration Date
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$50.00 •
TRENCH PR.RMLr
Pursuant to G.L.c:82A §rand 520 CMR 7.00 et seq.(as amended)
TATS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
Name of Applicant/I . „_. _I Mme of t Phone Cell
Street Aaa s° tuawAttivi PGI • • • 3598•P-il10 . 7)0,39' --1010
C /row INA ` 21p
Name of rater(if dine from applican
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Name of Owner's) Propertytle O2- 5
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Street Address .
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City/Town
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Other Contact
Description,location and purpose of proposed trench:
Please describe the exact location at the proposedi• s . -.( t'>G . p
be laid In proposed trench(egg plpS Ie lies.trenchase at . i aI . _ �( e 7—i---,70,1'.or' Intended)to
!a?e reyetae side If additional space Is heeded,
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Insurance CerliUcat—i Mi__
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Name and Contact Information of Insurer:
&'ers aMd .69 / • itr iu ta-t>t2_ ZD$ -361S.791 •-/
Poi Es.Iration Dater. ACIM. .
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Name of ompetept Person I • med by 520 MR 7.02n •
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