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TOWN OF YARMOUTH Old bp Kinj s r;tva�
1146 ROUTE 28, SOUTH YARMOUTH, MA 02884.4451 F.J.
IS i l Tew" (608i 398-2231 EM 1292-Fax (50a) 398-OBW t n
OLD KIND'S HIGHWAY HISTORIC DISTRICT COMMITTEE
APPLICATION FOR
CERTIFICATE 2LEXEMPTION
Application is hereby made for the issuance of a Certificate of Exemption under Sections 8 and 7 of Chapter 470 of
Acts of 1973, as amended, for the proposed work as dsscfibed below and on plans, drawings, or photographs
accompanying this appiicsAion.
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AN appliodkms mistbe pubmtHed by owrjor or oe lad loprfrom owner approving submittal fl!t�pp11"dom
u wv a w,=:.Ly4 AVISQ2 IW,,B 2 Year lnlAt: _ V
smart r 8 i"+41 Preferred nobfieatlon method. Ptane F.maa
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no6li aWn method
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Stgnsd (Owner or agenU. Data:
s OwsrarborxnetoApar l h aware lrrt a pama awy w nqulrw aom the wo Y
11 Tres aw0cm is gees aK ons year from approval des or epee data of esplwtton arn A H Perms, wtddlevsr due dare bs Ww
O.W. Approved Approved with changes _DanW
Mimi701 Reason f« denial.
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Data Signed: .1
APPLICATION ts,.AU ]
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25-077
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VAAUG 0 7 202!
0 Old King's Flig
Historic Dist
TOWN OF YARMOUTH
1146 ROUTE 28, SOUTH YARMOUTH. MASSACHUSETTS 02664.44St
Telephone (SN) 399.2231 Ext. 1292 Pax (508) 399-O 36
OLD KING'S IDGHWAY IDSTORIC DISTRICT COMMITTEE
WAIVER OF 45-DAY DETERMINATION
The applicanvapplicant' s agent understands and agrees that due to the current declared National and
state public health emergencies the determination of our Application for a Certificate of Appropriate
ness Demolition Exemption may not be made within 45 days of the tiling Of such application .
The applicant agrees to extend the time frame within which a determination is to be made as required
by the old King's Highway Regional Historic District Act.
SECTION 9-Meedings, Hearings, Time for Making Dderminatlons
"As soon as Convenient after srtch public hearing. but its anv event trithin jorry-five (45) clgvs after
the ftfing of 001cwtiwr ar within such fr lrrher rile as the applicant shall allot" in tvritiug, die
Coxrntittee shall make a determination on the appllcatiott. "
Applicant understands that the review of this application will be scheduled as soon as the situation
allows.
Applicant Agent Flame (please p ):
Applicant Agent signature: Date
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25-`077 1
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