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Massachusetts Department of Environmental Protection Provided try massD5-,,
Bureau of Resource Protection - Wet ands f.WsDEPFile Nunt w
WPA Forms 3 - Notice of intent
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Massachusetts Wettands Protection Act M.G.L. c. 131, §40
Town of Yarmouth Weiland By -Law, Chapter 143 city/Town
F. Signatures and Submittal Requirements
I hereby certify under the penalties of penury that the foregoing Notice of intent and accompanying
plans, documents, and supporting data are true and complete to the best of my knowledge. I understand
that the Conservation Commission will place notification of this Notice in a local newspaper at the
expense of the applicant in accordance with the wetlands regulations, 310 CMR 10.05(5}(a).
I further certfy under penalties of perjury that all abutters weam. notified of this application, pursuant to
the requirements of M.G.L. c. 131, § 40, Notice must be made by Certificate of Failing or In writing by
hand delivery or eydif � m 'I return receipt requested) to all abutters within 100 feel of the property tine
of the {eC. to
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S, S+gnatum of Representative of any) 6, Oate
For Conseryatfon Commission:
Two coplas of the completed Notice of Intent (Form 3), including supporting plans and documents.
two copies of the NOI Wetland Fee Transmittal Form, and the city/town fee payment, to the
Conservation Commission by certified mall or hand deWery.
For MassDEP:
One copy of the completed Notice of Intent (Form 3), including supporting plans and documents, one
copy of the NOI Wetland Fee Transmittal Form, and a copy of the stato fee payment to the
MassDER Regional Office (see Instructions) by certified mail or hand delivery.
Other:
If the applicant has chacked the 'yes' box in any part of Section C, Item 3, above, refer to that
section and the Instructions for additional submittal requlrernants.
The original and copies must be sent simultaneously, Fallurs by the applicant to send copies in a
timely manner may result in dismissal of the Notice of intent.
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