HomeMy WebLinkAboutSite Access Authorization Form Yarmouth Conservation Commission • 1146 Route 28 • South Yarmouth, MA 02664-4492
Tel. (508)-398-2231 Ext. 1288 • Fax (508)-398-0836 • TTD# (508) 398-2231
Site Access Authorization Form
General Information:
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.
Property Address: _2 Buttercup Ln_________________________________________________
Assessors Map/Lot: _119-33________________________________________________
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 information regarding the
application filed with the Commission pursuant to the Wetlands Protection Act (M.G.L. Ch. 131, s.
40) and/or the Yarmouth Wetlands Protection Bylaw (Chapter 143).
Authorized Signature: ___Wayne Tavares_____________________ Date: 09-23-2021_
Please Print Name: ___Wayne Tavares________________________
If other than owner, please state whether tenant, agent, or other: __Agent___
Mailing Address: ___PO Box 1580-Sagamore Beach, MA 02562______________
________________________________________________
Phone: ___508-642-7701____ Cell: _508-642-7701__________
Email: _wettechlanddesign@gmail.com__Fax: ______scanned e-mails only___
DEPARTMENT
OF
CONSERVATION