HomeMy WebLinkAboutBLDT-23-2079- TOWN OF YARMOUTH
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` BUILDING DEPARTMENT Permit Number
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_'r y_ 1136 Route 28,South Yarmouth,MA 02664
„ �zrf w 5l8-398.2231 ext. 1261 Fax S08-3"98.0836 Date Issued
�.. Expiration Date
$50.00
TRENCH PERMIT
pursuant to GI..c.8 t and 520 CM*/AO et sages amended)
rues Pawn.mum'is FULLY COMPLETED PRIOR TO CONSIDERATION
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Street Addreie
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Name of Owneron u1 Property Phone ['ell
StreeDaA s. Goda‘ty
tt3. 531• 6({63
133 Clear etcoo)i-
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fklior Centact I Ices wed :Not 1 Yee l
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Pkost describe the mart lasatine art tbs proposed math sad its popper tt siebtd.a dleinripdoo of what is tar is int coded)to
be laid is proposed trench tem Optima*Sato ear..)Plum use amens Ad*itadditionmi upsetIs ateded.
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RECEIVF
AUG 4 9 2023
UILDING DEPARTMENT
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Name of C«wnprtens a tree defined tor S2*t'MR tele
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Massuchwetis Raking Liam*• HE- oq trio
UM")Grade: Ex time
7-4241124 BY =Nam rills FORM,THE APPLICANT,OWN
TEAT TREY AID IaAM� �`"AND EXCAVATOR ALL ACKNOWLEDGEAND armyERR MMZNCU t Off roE won %" .BECOME F'AMtLLot
wrTtl,ALL LAWS AND EMULATIONS APPLICABLE TO WM POP %INCLUDING OM.;RI*MUTATIONS,
C.L. e. ITIA, FM CM TYw +M to4, AND ANY APPLIcAlLit MUNICIPAL ORDINANCES* IFF-LAWS AND
IIEGULATIONS AND THEY covemirr.AND ACID TRAY ALL won `UNDERnor ream vim.FOR
SUCH WORK WILL COMPLY 111EIIEWITII IN ALL locsprers AND wiT0 THE CONDITIONS SET FORTH
BELOW.
TIItt UNDWIGNID OWN= AVTEORIXO TEE A PNJ CA14"t TO APPLY FOR TAR MEET AND TIE
EXCAVATOR I LJrorr?,U 911CH woos ON TEE PROPERTY Or TEE
I 'RAT 4 OF C At rHQH RRI DULY A ' p 0 AND ALSO* FOR TH
EErma UPON THE PROPER K INTY" TO MON AND P'IICr T _Iou "ALt'i'�!` 'lam
CONf�ATTAC D Warm AND? . AND RR.. 1 rry Tux
K.
Da*UNDERSIGNED APPLICANT,OWNER AND EXCAVAIOR AG*JOINTLY AND*VZLtLLT TO
REIMBURSE TIER CIPALITY MEANT AND ALL COSTS AND"RIIREEMET-
MUIVICIPALITY IN T C'O DY TON
EXCLUDING tall" LIMITED
mar TO Z
THIS or STATE.LAW AND .
TriAor,mamma MAU TO MIME COABFILANtRrOr
hIUNICI►A TY TO PRO I l`TRZIUILIC IIrR� R AND11�Xu'MIEN IEYTES
COlt PLY TH I1Ci� Y ;T APP CIS wYA �~tA 'I"
NECESSARY BY THE MUNICIPAUTY.
TEE uNimminninim APlt 4CAl Y,OWNER AND EXCAVATOR AGREE ICY AND SEVERALLY TO OW NIX
NNDI SWOT',AND SOLD HAMMES TEE EIREUCIPALITY AND ALL Or TIE A SMS AND EMPLOY
ANY AND ALL LIABILITY.CAUSES OR ACTION, I r`TA,�, ,�f�OR ARMING OUT
tow�rrtA},M�'Y URT�,, D,EATH'y,y WES 1 DAMAGE " AN!" tUSt C PR�"Y R , TEE "miE
CONW�UNDER TIM mown'.
APPU SIG HE
DATE "' #
EXC VATOR GNAT (I DIF to IT)
DAB
OWNER'S SIGNATURE(IF DIFFERENT)
DATA
111,1.
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