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MANAGER /SEASONAL EMPLOYEE HOUSING PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department 6 ""��( .y-4 r
1146 Route 28 ' ' `
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261
APPLICATION FOR: MANAGER UNIT(S) 1 SEASONAL EMPLOYEE HOUSING
HOTEL/MOTEL ADDRESS: \ 3C SQ(1), 1 \ s 1 1` . cAr c)ksv (ÔAXc QpA 1 r 1ff
SPECIFY STREET#AND NAME SPECIFY SOUTH,WEST OR YARMOUTH PORT
OWNER: \5( (),A(r) ' ' l V \VLy ♦QJAc-V ` , '5V(( lc ` SV.— ! cir- i)
NAME
LEGAL ADDRESS� TEL. #
MANAGER: T `,,,,\\ � `�S J\t \ 2 JC7 'Li 1 ; l 1 ` kk. I C7-) � � JV�_�31--(05/�
NAME LEGAL ADDRESS I\ 2Q g
ON SITE PROCTOR �; 1 l �C Ii7�SZ Q1. ) 5 Vs—J J -a533
NAME Ic ROOM NUMBER CELL#
TOTAL NUMBER OF LICENSED ROOMS: ' Lf ,,
NUMBER OF MANAGER/OWNER UNITS 1 ROOM NUMBERS l_q _____I__R C E I V E D
NUMBER OF SEASONAL HOUSING UNITS: l...- (APRIL 1st-OCTOBER 3151) 1
APR 2 2 2024
15% MAX J
ROOM NUMBERS: BUILDING DEPARTMENT
tit: -- — -
INITIAL
I will comply with all applicable Town of Yarmouth Zoning Bylaws and all other applicable laws.
Seasonal employee housing shall be used solely by employees and shall not include family members or non-employees.
I understand that any false statement(s)will be just cause for denial or revocation of my permit and may result in the town
taking further legal action.
I declare under penalt'•s of perjur that the statements herein contained are true and correct., \ i `-( ,
Applicant's Signature: ,__ �, -_ Date: a Lt a
O��ner's Signature(or a to•h1,r t/�ment) • / � Date:` 'J Lita__ __________
kpprosed By: Date: - -
Building Commissioner(or designee)
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