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Yarmouth Conservation Commission -`ie
Administrative Review
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Applicant Information: ZZOZ r 1917b
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Name: .J /Y/l%s / '7✓i? 5-1,9 '3 , al 0 cv
Mailing Address: '12 v t f 0 F s 0• / ZNAOOT C (-0- o ;2‘U
Phone: �D �^ 7??- . :(72 yU Email: J K Sn/3447 2 /Y(SW. e!'/4
6/Z____________Signature:
Location of Work: / PC) WZ Y. Z.. kV )i T 4 0 JT Pos.-7, f
Street Name and Number
Please Note:By submitting this application the applicant grants permission to the Conservation Office to enter the location to conduct a site visit(if needed).
Detailed Description and Reason for Proposed Work:
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Closest Distance to Resource Area: If\ ?) Vi
Proposed Start Date: j9,5-MP
Company to do Work:
Name:
Address:
Phone: Email:
Administrative Approval:
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This approval is valid for one year. This Approval does not grant any property rights or any exclusive privileges;it does not
authorize any injury to private property or invasion of property.
Yarmouth Conservation Commission • 1146 Route 28,South Yarmouth, MA 02664• (508)398-2231 • Ext 1288