HomeMy WebLinkAbout271 Setucket Road, SE83-2165, Site Access AuthDEPARTMENTor
CONSERVATIOII
Gcneml Jnhxmatian:
Ii the applicant is not the property owner, please submit this form with your application. The owner
must be sent a copy of the application on the same day it is filed v'ith this office.
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Sitp Grseo o {k$&sxi,zotisn *arnt
Property Address:
137 -71
Assessors Mapll-ot;
I (we) hereby authorize the individual members of the Yarmouth Conservation Commission and its
agents 10 enter upon the referencad property for the purpose of gathering information regarding the
application filed with the Commission pursuant to the Wetlards Protection Act (M.G.L. Ch. 131. s.
40) alrd/or the Yarmouth tion Bylaw (Chapter i43)
'/7iz!!Authorized Signature:
Please Print Nam ", &'',13,t rK4
lf otber than owner, please state whether tenantr agent, or other:
Mailing Address:r/utzlY /n, <
oot'l'lBcRoi.t G,
O) 772
Date:
p6,,". 3V7'y'll Cell:5or-q7/. /[7E,J14<'
Ema ilz /'7ur|,+ Q fY i7ott, "tot Fax:
yarmouth conservation commission. 1146 Route 28 . South Yarmouth,w\ 026644492
Tel. (508)-398-2231 Ext. 1288 ' Fax (508)-398-0836 'TTD# (508) 398-2231
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