HomeMy WebLinkAbout0187 BARNSTABLE ROAD - Health 187 BARNSTABLE RD., HYANNIS
A=310-154 __r
10
1
Q
I
RECEIVED
Ly��pfHET o NlAk- 12 "L001 DATE:
TOWN OF BARNSTA8LE FEE
IARNSrABLE MASS. HEALTH DEPT.
y
$p 019. `m� REC. BY
A 'Town of Barnstable
SCHED. DATE:
Board of Health
367 Main Street, Hyannis MA 02601
Office: 508-862-4644 Susan G.Rask,R.S.
FAX: 508-790-6304 Sumner Kaufman,M.S.P.H.
Ralph A.Murphy,M.D.
VARIANCE REQUEST FORM
LOCATION 1 v sgwstop 1 c R,b• **.VA1*&
Property Address: 1 9)
31D - 1S'1 Ig 7 — AffftW `RA,
Assessor's Map and Parcel Number: 310 — ,2$9 Size of Lot:j91
Wetlands Within 300 Ft. Yes Business Name:
No Subdivision Name:
APPLICANT'S NAME: 13p3GR `f: Spgml gJA Phone SO& 4WA)A&6 p1WV�
Did the owner of the property authorize you to represent him or her? Yes No
PROPERTY OWNER'S NAME CONTACT PERSON
Iona-
Name: go-arL " `T'. '5MWXLR Name: 5PKINA ' �50pvN14LIie
Address: 1L COyff_ Rb DAWNA Address: 197 A lely�S
so&- 398- ze Sry
Phone: q 1 f l!Z_S 3 01 / at I a Phone: 7 1 7 7 k
VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May atttach�f mgie)spaaSceaneeded)
6
e S ,
A/aN dSFh
NATURE OF WORK: House Addition ❑ `H� eatien-®pair �y
~ ov�— A
Checklist(to be completed by office staff-person receiving variance request application)
_ Four(4)copies of the completed variance request form
_ Four(4)copies of engineered plan submitted(e.g.septic system plans)
Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)
Signed letter stating that the property owner authorized you to represent him/her for this request
Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense
(for Title V and/or local sewage regulation variances only)
_ Full menu submitted(for grease trap variance requests only)
Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same
owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems
[only if no expansion to the building proposed])
Variance request submitted at least 15 days prior to meeting date
VARIANCE APPROVED Susan G.Rask,R.S.,Chairman
NOT APPROVED Sumner Kaufman,M.S.P.H.
REASON FOR DISAPPROVAL Ralph A.Murphy,M.D.
Q:/WP/VARIREQ