HomeMy WebLinkAboutImage_003.pdf - BLDT-24-19 35738TOWN OF YARMOUTH
BUILDING DEPARTMENT
l146 Route 28, South Yarmourh. MA 02664
50E-398-2231 ext. t26l Fax 508-398-0836
Permit Number
Date Issued
Expiration Date U(A 81./
TRENCH PERMIT
Pursuant to G.L. c. t2A !l aad 520 CMR 7.00 et scq.(as amended)
NIIS PENJUTT MUST BE FTILLY COMPT.EIf,D PRIOR TO CONSIDEf,ATION
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BY SIGIIING THIS FORM. TIIE APPLICANT, owMR, AND ExCj,YAToR ALL ACKN0wLEDGE AND CERTIFYrHAr rrrEy ARE FAMTLTAR wrrH, oilni'bd a6'iifiilicryrn, ori*t-w6Rn, ;fi., BEcoME FAMTLTARwrrH' ALL LAws AND REGULATToNs arpuiasiitiifronx nn6nqsirnlriidffiint'o.rA REGULATT.NS,G'L' c' 82A, s20 cMR 7.00^-er seg, AND ANy a*llc1y1_n_.gtl*CrpAl OrnmaNcrs, By_LAws ANnREGrJLArroNs AND rrrEy corrnx,r.'ilr ar.ro GfuE;irft lrr_woni oorlr:uffin*nTfii prnurr rssu,D FoR;H:5#"* w,Ll coMply mrnrwirn il'Tri"iispncrs ,nu-wiin iffi--co,r,lnmroNs sEr FoRrH
T[tE UNDERSIGMD OWNER- AUTH.ORIZES TIM APPLICANT TO APPLY FOR TIIE PERMIT AND TIIEExcAvAroR ro TJNDERTAKE-sucH w-oni o,irfii'i'iroprmr-oi:-iff offiri.i"^", Arso, FoR rrrEDURATToN oF coNSlRUCrroN, aurno-mzni', rnns*oNi rulv nproivili tilfrr rrrrNrc*orrry roENrER upoN rrrE pRopERTy_io-uoxiion m6xi:eng: inr wonri-r'oi'coiii"oruury wrrH rrrECONDIIIONS AITACIIED IIERETO ANDiITE iA\i,i iXO. iiCtUTTONS GOYERING SUCH WORK.
TIIE UNDERSIGNED APPLICANT,-OWNER AND EXCAVATOR AGREE JOINTLY AND SEYERALLY TOR3IMBT]RSE TIrR MU^.ICIPAI-ITYTOIEIV_IIVO Iii CiI'S"rS ENU BXIENSES INCURRED BY TIMMUMCIPALITY IN COMIECTIONWITS i,os i;EIffi"I."NO 1P YONT
'ONDN'C"TdE;iREUNDER,
NCLUDING Btrr Nor LIMTTED ro nrvroncnic frfr nldunrngxrs or si"l"ri'r{d ffio coNDrrroNs oFrHrs pERMrr. rNsprcno:vs in,rn_p-io i.airdcffifixiis-r-umnewrrir. iffi-frriiu*rs rAKEN By rHEMUMCTPALITY ro PRorECr-rIIE^fqtI,i,c wlmfi'ririTirurg.aNrtvrxi:iiiintitl'viro*,AS FATLED roS3&:.IIffi ffi H,ffi :$Dfl{ff lucnoir;ffi i;"6"onunn_uurorairi-r"isiiiiorBruBo
TIIE UNIDERSIGNED APPLICANT,_9II,EI AND EXCAVATOR AGREE J9INTLY AND SEVERALLY TO DEFEND,IIIDEMNIFY, AND TIOLD IIARII_IP^SS.JHE MU^,CTP-ii,,Y"AND-1_L]! OF ITS AGENTS AND EMPLOYEES FROMA\T Ar\D ArL LL'lBILrrY' c{Ir--sES on,r,ciiiilr',-cttii, iru_e_xprxsrsnrsiliiNc'HLM oR ARrsrNG our3[^ffir;Hffibi"rffii"l_Si,ri.on'ilil,ilH?d.i$ prnsor. oR*pi.offiRil]uRrNc rrrE woRx
APPLICANT SIGNATURE
EXCAVATORSIGNA (M'DMFERENT)
OWNER'S SIGNATURE (IF DIFFERENT)
DATE /7-
-DATE
DATE: