HomeMy WebLinkAbout19-A042-A3 REClV
DEC 76201 4
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TOWf;
SOUTH Y '1)11.6... TOWN OF YARMOUTH
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f' _ - . A C 1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-4451
M 7T ',�,-2' Telephone(508)398-2231 Ext. 1292 Fax(508)398-0836
`.,,, -i' OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
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 ,I
Original Application #: iti-Mil_ 11t�I Al. Original Approval Date: ' II;1ILI, J l411(f I('jjq/CI
Address of proposed work: 3I- r^ y V-0.4`'%) I& N'1/4',Jh 1�l,l'1�}' I,(� 1/64 ' M . (j24 7
Owner(s): ->1X-V t'\ C fliti I Phone#:
Mailing address: 27) t1'i Ilirls UK Vt(. 1) .fti M V4. ( 3d(
Email: fi cdt‘UNA 11 1 , (,u\ 101
Preferred notification method: ? honeK-Email US Mail
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Agent/Contractor: .5.1 .1�i' �� I / ,Jinn tio"V 14\, Phone#: kAl- 211 " .J L� 1
Email: J - bpi yam\ 1C Iitym I . (.(;('i Preferre notification method: '1 Phone Email
Please describe proposed change(s) and attach plans/photos (as necessary):
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Signed (Owner or Agent) halift Cla W'Will Date I ZI 1 I 1 i H
V Approved by OKH _ Denied by OKH New C/A required? Yes No
Reason for Denial:
;iH
OLD KING'S HIGHWAY
Signed OKH ChairmanA4 Date <-/Z12 O/ 9
AMENDMENT# i 9- A- 6.-Q -i3
11/2015
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