HomeMy WebLinkAbout9 Vacation Lane paper application #1I
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Smoke Detectors and Carbon Monoxide Detectors are Required!
owners: I have ensured the batteries are changed, have tested ALL smoke Detectors{ca
Monoxide Detectors and verified that they are less than lo years old: p/ease initial (;,b
Contact the Building Depanment regarding questions on type and tocation prior to purchalii!-
httos://wryvw varmouth.ma.us/DocumenlCenler/View1 1221lSmoke_detector_location
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Rental Property lnformation
All fields are t uired! lncom eb forms withoul a valid one # or email cannot be rocessed
A non-refundabte apptication fee of $80 pef Uniufental js required.
Rental Certificates expire on December 31"t, 2024.
lf NOT registering online, please makechecks payable to: Town of YanrDuth and mail completed application &
payment to: Town of Yarmouth Health Department.
The Health De aftment willcallto schedule an i if required,recoipt of yourapplication and fee
\U"-\} t*iRental Pro perty Address
/*Ann ual
Rental Period
asonal Short Term (less than 3'1 days)Trash Removal bv:
owner- t.n^nt /nousefiuptex-conao_ Apartment_ Room
Rental of:
Property Owner NamE
Keo t hot,BlUq'o
Mailing Address:3t OStc 51 firlarc ,,,?rn 0ZO1S
( required)Primary Phone Iilo.
tub- 6?8- rmt
Alternate Phone No (required)E-mail Address
Krrl@B Atsmo orsp.r,rrL. cur"
owners ReoresentatiteTRenta-AgenUAgeney
3,1^^,i,q Otor".
Primary Phone No
5k- bs?3
(required)E-mail Address
d,,rt. Lr s,S47)f ,ryr, r(-.corr
Furthermore l understand I must notify the Health Department in writing when I am no longer renting the property, or I may besub.iect to fines and bes.
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1MState SanitaryhttDs://www e,Chapter Minimum Standa rds of Fitness
sino-Prooramrmouth.ma.u 423/RentalHo
I Bylaw
which a
ara ownaYUtrmohShoTrtRenermtaa rcable thande(rf ppl
fo uH am Hn baita nio al of re a a able ouon SIbte
Sign Date: I
Revised 1O/23l2024
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