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HomeMy WebLinkAbout14 Niagara Lane paper applicationApplication tor 2024 Rental Registration Health Department 1I45 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664 Telephone (508) 398-2231 , e\t. t Z4O Fax (s08) 760-3472 E-mail: epolite@yarmouth. ma. us\ L;.-.p"(;l. it r-https ://varmouthma. portal.openqov. com/ strati hT T ofown aY rm outh excitedS anto on ncu th we'VE strea m n theed no n tast no Sregproces k mo SEu fri den s mthnaevebefore itispl tolyv getrtedtaTheUoeffortlesslcreateUoarcoucantdnVEconnYhnoYvfeeientlypaYreg 't+ srgned S n h s u ta edd uosp thUS or h utosystemv entithe TE cesroSugp ou but asecur€ly you sdocumentsogirnpo*aflt b o u oad hotos and UCm mho Th is mitv roved atform dspp matoke uotp shati nopvreg n SM aooth dn ceffi nt. TOWN OF YARMOUTH arbon oM onX ed A non-refundabteapptication fee of $80 pef UniUfental is requared. Rental Certificates expire on December 31st, 2024. lf NOT registering online, please make checks payable to: Town of Yarmouth and mail completed application & payment to: Town of Yarmouth Health Department. cation and feeurauired, upon receipt ofnt willcallto schedule an inspection ifThe Health De rtme Rental Property lnformation All fields are ! lnc forms without a valid # or email cannot be ssed Ren t4 tal Property t{r"1rrro- Address Lane,J{,MAWe+o Sea"onat/Short Termnual Sless than 31 d Rental Period Remo Tenant val byTrash Owne ouse rtment RoomDUlex Condo Rental of: r"{+ [.'i KO' Pro s4rt231 Owner Name 3?[fE::i LJ,s.A,J, r..rY rr?83 t 516.(60.Bzqq requt ty ne o Alternate Phone No Cet{sro.?32 .q4bg mail Address: . lz.,o..@ g.oi\ E S resep nt/e encAgAgv Primary Phone No (required)-mail Address partrnent in writing when I am no longer renting the prcperty, or I may be \7Date 9d Sign ous State Sanita ryco Chapter 2o23 I Bvlaw which a have re ma aman n rmoaU aYrmo Shuth Torte Rermnta icable a thend(if appl H TNUanfo Ha itatiob n a of re avat bla oe onu Ltbse n m mu Sta FofndaS SneS Furlherm I understand I mu the Health Desubject t and ownose Revised 1 23 J-\ have the power to engage with Not only co!'nmunicate \44ttrotll team, Owners: I 'T'-\ I4.-Xrttb*'