HomeMy WebLinkAboutRDALlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands Yarmouth
PA Form 1- Request for Determination of Applicability City/Town
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
Important:
When filling out 1 • Applicant:
forms on the Amedee Prouvost
computer, use Name E-Mail Address
only the tab key to move your 4717 Essex Ave
cursor - do not Mailing Address
use the return Chevy Chase MD 20815
key. Cityrrown State Zip Code
C
Phone Number Fax Number (if applicable)
2. Representative (if any):
Firm
Garry Ellis
Contact Name E-Mail Address
33 Town Hall Ave
Mailing Address
South Yarmouth MA 02664
City/Town State Zip Code
(774)487-0355
Phone Number Fax Number (if applicable)
B. Determinations
1. 1 request the Yarmouth make the following determination(s). Check any that apply:
Conservation Commission
❑✓ a. whether the area depicted on plan(s) and/or map(s) referenced below is an area subject to
jurisdiction of the Wetlands Protection Act.
❑ b. whether the boundaries of resource area(s) depicted on plan(s) and/or map(s) referenced
below are accurately delineated.
✓❑ c. whether the work depicted on plan(s) referenced below is subject to the Wetlands Protection Act.
❑� d. whether the area and/or work depicted on plan(s) referenced below is subject to the jurisdiction
of any municipal wetlands ordinance or bylaw of:
Yarmouth
Name of Municipality
❑ e. whether the following scope of alternatives is adequate for work in the Riverfront Area as
depicted on referenced plan(s).
wpafonnl.doc • rev. 7/27/2020 WPA Forth 1 — Request for Determination of Applicability • Page 1 of 4