HomeMy WebLinkAbout21-E010-A1 159 Wianno RoadTOWN OF YARMOUTH R [� .r
' 1146 ROUTE 28, SOUTH YARMOUTH, I11ASSACHUSETTS 02664-4451 ' "�"' ~ �D
Telephone (508) 398-2231 Ext. 1292 Fax (508) 398-0836 Q� 0 4 Z�Z1
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,. OLD KING'S HIGHWAY HISTORIC DISTRICT CONIAIITTEE
YARN)OUTH
AMENDMENT FORM OLD KING'S HIGHW
("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 PRI11NTj LEGIBLY r�
Original Application #: a I —� C. 0 D Original Approval Date:
Address of proposed work:
Owner(s): W) l 1ney DCV�S Z&eDcV1 5 Phone #:2S
Mailing address: /J71 W G O �W)Gtl Gt '/
Email: Preferred notification method: V Phone _Email _US Mail
Agent/Contractor: GLJ IC_ � 1 Phone #:
Email: `! Q (�(J{ r�/��Ir!!C,S j f11p f Preferred notification method: V Phone '✓Email
Please describe proposed change(s) and attach plans/photos (as necessary):
...................................................
Date 11 ! i F
Approved by OKH Denied by OKH New CIA required? Yes No
Reason for Denial:
Signed OKH Chairman
1112015
Date
AMENDMENT # �) -1501 D --
REbE FV
E
D
NOV 0 4 202I
YARMOUTH
OLD KINGS HiGHw
AY
AL
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