HomeMy WebLinkAboutYarmouth Stormwater Permit Application
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Town of Yarmouth Stormwater By-Law Ch. 145
Stormwater Management Permit Application
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A. General Information
1. Project Location:
a. Street Address
b. City/Town
c. Zip Code
Latitude and Longitude:
d. Latitude
e. Longitude
f. Assessors Map/Plat Number
g. Parcel /Lot Number
2. Applicant:
a. First Name
b. Last Name
c. Organization
d. Street Address
e. City/Town
f. State
g. Zip Code
h. Phone Number
j. Email Address
3. Property owner (required if different from applicant): Check if more than one owner
a. First Name
b. Last Name
c. Organization
d. Street Address
e. City/Town
f. State
g. Zip Code
h. Phone Number
j. Email address
4. Representative (if any):
a. First Name
b. Last Name
c. Company
d. Street Address
e. City/Town
f. State
g. Zip Code
h. Phone Number
j. Email address
5. Total Fee Paid:
a. Total Fee Paid
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Town of Yarmouth Stormwater By-Law Ch. 145
Stormwater Management Permit Application
A. General Information (continued)
6. General Project Description:
7. Property recorded at the Registry of Deeds for:
a. County
b. Certificate # (if registered land)
c. Book
d. Page Number
B. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Stormwater Management Permit
Application 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
application in a local newspaper at the expense of the applicant.
I further certify under penalties of perjury that all abutters were notified of this application, pursuant to
the requirements of the Yarmouth Stormwater Management Regulations in writing by hand delivery or
certified mail (return receipt requested) to all abutters within 100 feet of the property line of the project
location.
Signature of Applicant
Signature of Property Owner (if different)
Signature of Representative (if any)
Date_____________________