HomeMy WebLinkAboutAdministrative Review 9.20.22 Approved �1•Y
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Yarmouth Conservation Commission V i -
Administrative Review St r' 1 p
Applicant Information: /
Name: / G4 of r- , 1-6 t.J 1.-- By
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Mailing
Mailing Address: -5/-Y , / f
Phone: 6/7 02/a 0 Email: pi'neS� 1/ ( e2 — 'Utes c7
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I hereby authorize the individual members of the Yarmouth Conservation Commission and its agent(s)to enter upon the property listed
below for the purpose of gathering information regarding this Administrative Review form.
Property/Location of Work: // S 13;-`t.r 27, /f'/i7 f- R,r
Street Name and Number
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Signature:
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Detailed Description and Reason for Proposed Work: /pi. i-•i U d`C z'ea / -74.i`-C'-e---
)Closest Distance to Resource Area: ? V ' + 4-U 6U`&
Proposed Start Date: -
Company to do Work: l
Name: �rJGc Pt_ 2- -d6 //- 7,-..., e ,fe/-v/c. -t- •
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