HomeMy WebLinkAbout18-A083-A1 C�
0 A4,. TOWN OF YARMOUTHR CEIVE ;
le' 9 1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-44_1
YM� ss^ Telephone (508)398-2231 Ext. 1292 Fax(508)398-0836 / ! 16 C f+f
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTElirYAKIVIUU I h
OLD KING'S HIGHWAY
AMENDMENT FORM
("MINOR CHANGE REQUEST")
A minor change request must be submitted within one year of the original approval date or while the work is still in
progress. Only a minor change may be approved by the Committee without the filing of a new application.
PLEASE TYPE OR PRINT LEGIBLY
Original Application #: i Pr(<<S j Original Approval Date:
Address of proposed work: Co-fc'1/4 , Lam.-- ]y u-dvb
Owner(s): Co-aa s y 6 uf k y n al9j- r TODhone#: 54'4/Zg"t! c o E 6 u
Mailing address: /6141 f -a i 3 fy o-wvLoS f d A Z 6)c(
Email: Preferred notification method: Phone_Email,KUS Mail
Agent/Contractor: E.3 . if.)&6- S ��'� L • Phone #:
1
Email:.�e fr ��S Preferred notification method: Phone Email
Please describe proposed change(s) and attach plans/photos (as necessary): �tr✓"
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Signed (Owner or Agent)J1t .v\� �
d o , 1)5' 05 S -(i Date /2/1(../(1
V Approved by OKH Denied by OKH New C/A required? Yes No
Reason for Denial: RECEIVED /AiPROVETJ
1A4 i 172.019
TOWN CLERK YARMOUTH
SOI ITI-1 YARMOUTH Dq.. OLD KING'S HIGHWAY
-c 3Signed OKH Chairman _ C1 • b • Date 1//
AMENDMENT #
11/2015
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REC i��1�1 R�C�IVED
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