HomeMy WebLinkAboutSE83-2168 NOI Site AccessDEPARTMENT
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CONSERVATION
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If 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 with this office.
Propefty Address:C
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Assessors NIap/Lot:/z/
I (we) hereby authorize the individual members of the Yarmouth Conservation Commission and its
agents to enter upon the referenced property for the purpose of gathering infonnation regarding the
application filed with the Commission pursuant to the Wetlands Protection Act (M.G.L. Ch. l3l, s.
40) and/or the Yarmouth Wetlands Protection Bylaw (Chapter 143).
Authorized Signature
Please Print Name:f,:u"*
Date:
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Phone:
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Cell:-6uri - B5Tbil-?*26
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Yamouth Conservation Commission' 1146 Route 28'South Yarmouth, MA 02664'4492
Tel. (508)-398-2231 Ext. 1288' Fax (508)-398-0836' TTD# (508) 398-2231
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If other than owner, please state whether ten&nt, agent' or other:
Mailing Address:
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