HomeMy WebLinkAboutRental Application2OZS Rental Registration Application
Smoke Detectors and Carbon Monoxide Detectors are Requ
Owners: I have ensured the batteries are changed, have tested ALL Smoke Detectors
Monoxide Detectors and verified that they are less than 10 y
Contectthe Buildlng Depanment reSardinS questions on lype and location priorto purchasi
httos, / /wwfv.
n
ears old:
ng.
ired !
A rn"rrefundable apptication fee of $BO per unit/rental is required
Rental Certrficates expire on December 31''t ' 2025.
your application online. After completing the initial steps, make your check p
Yarmouth, and be sure to include your BHR number (which will be provided
application process) and your rental address. Make a note in the notes section that you will be
sending a check. Mail the check to the address above
lf NoT registering online, please make checks payable to: Town of Yarmouth and mail
completed applicition (on reverse side) &payment to: Town of Yarmouth Health Department
See Reverse Side -'---'-----)
To register online and
website: https://www.
Town of Yarmouth Health Department
fyou prefer to pay by chec( you may begin
pay via credit card,
varm o uth. nta.u s / 127
visit the
/ Hcalth I
ayable to the Town of
during the online
TOWN OF YARMOUTH
Health Department
I I46 ROTJTE 28. SOUTH YARMOI,JTH
MASSA('HT]SETTS 02664
1'elephone (508) 398-22J1, err. 1240
Far (508) 760-3472
E-maili m dale\ /a\'. rmouth.ma.us
Important Notice (PLEASE READ CAREFULLY):
cords, septic system, the number ofbedrooms and previous inspections.
*An inspection may be required as part of this process
f you do not receive your rental certificate within 30 days of sending in your application, please contact our
ffice immediately! please be aware that until you receive a rental certificate from the Health DepartmenL your
roperty is being rented without a valid certificate, which may result in fines and other penalties.
ubmitting the registration application !ggp! complete the process or guarantee the automatic issuance of
rental .e-rtificate. Your applicition will undirgo a *review process, which includes verification ofassessors'
Please note that occupancy limits are in place based on septic capacity and the number of
bedrooms. These measures are in place to protect our drinking water and aquifers. As
Yarmoutl prepares for a fufure transition to a town sewer system, these steps are crucial
for preserving our water resources. Previous occupancy determinations may be subiect to
adiustment based on the criteria mentioned above.
Io
All fields are required! lncom
Please Print Clearly
Rental Property tnformation
s witholtt a volicl phone i, address. ,tr e-nplete form ail address will not processed
A/'4-
{/
Rental Property Address
lz
Rental period:
ear-Rou ndlLone T .r^d-r'/-'
eekly/Short Term [less than 31 days) _
Tena ner
Trash Removal by:Rental of
N^House_ Duplex_ Co partment_ Room_
Zfrre v c/erz-l<- 7-<u-r7-
? ,?Ylo 4o,D o o)or-- e,/,g rz /<-
roperty Owner Full Name:requ ired) Entire Majline//t rz*at -ZYr9Uzt6arlO,
Address:
7tLT o262s-
5"8-364 -22,/6
onereq u re um ermary
.tu*-fat->at 2
Alternate Phone Number:(required)E-mail Address:Aordor.- @rvrze/S /"
?4z
Age
Nee
ne s rCS neta venoal\l reDt/
d a acati no o ethr acasa, We
enta
3q)zzs-dso
Representatire's Primary P ne
Number:Representadve's E-mail Address
Furthermore, I understand r must notiE/ the Health Department in writing when I am no longer renting theproperty, or I may be subject to fines & fees.
fo fe
h TCe lr ca nk de tha t h a re aed dn aIN frr t thhve of rma ht C ha r 80RnptetaHoLIsnaCharteBy04NpsBeheaToonYfrmavllothshrtoTen)f eRIIta B a ha reecbaendthl\leapp as hc seLI Stts tate nSa ta C do e haCry re M n m LIpmt o Ff tn es fos HT n'lu tlaHbtatlnoThsedc()ntl-l ne ats afe a lab c r re re ct')()e thn e To s he ate dn am a oIs obe tab t1 evrtreuetsrotthmYeqraon1theHahDertmat1ep
,AN A;) ZuL )
HEATIH DEPI
Revised: 11 024
,4outsitazdd
familiar Town ,s 1IAnti-
),Standards)
u pon