HomeMy WebLinkAbout0628 MAIN STREET (HYANNIS) - Health 628 Mai`n;Stre. an i we•;
Hyannis
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Board of Health 6666
200 Main Street,Hyannis MA 02601
Office: 508-862-4644 Susan G.Rask,R.S.
FAX: 508-790-6304 Sumner Kaufman,M.S.P.H.
Wayne A.Miller,M.D.
VARIANCE REQUEST FORM
LOCATION //
Property Address: C®,2� r�
Assessor's Map and Parcel Number: Size of Lot:
Wetlands Within 300 Ft. Yes Business Name:
N,o/ Subdivision Name:
APPLICANT'S NAME: l�jJVC eAt 671 JOldl' Phone O� f&d Q 410,r
Did the owner of the property authorize you to represent him or her? Yes No E
PROPERTY OWNER'S NAME CONTACT PERSON
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Name: d I d /2c6�r' Name: V U ' 61901.1
Address: Address: CP 2A 44A
Phone: 4?(O2- &2-'V Phone: !iE6 2 � b 7
VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed)
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NATURE OF WORIt''House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑
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 syst(lm 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 Wayne A.Miller,M.D.
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