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` Bureau of Water Resources - Wetlands
WPA Form I - Request for Determination of Applicability Yarmouth
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Municipality
C. 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 above is an area subject to
jurisdiction of the Wetlands Protection Act.
Al b. whether the boundaries of resource area(s) depicted on plan(s) and/or map(s) referenced
above are accurately delineated,
c. whether the Activities depicted on plan(s) referenced above is subject to the Wetlands
Protection Act and its regulations.
0 d. whether the area and/or Activities depicted on plan(s) referenced above is subject to the
jurisdiction of any municipal wetlands' ordinance or bylaw of:
Yarmouth
Name of Munclpality
❑ e. whether the following scope of alternatives is adequate for Activities in the Riverfront Area as
depicted on referenced plan(s).
D. Signatures and Submittal Requirements
hereby certify under the penaltles of perjury that the foregoing Request for Determination of Applicability
and accompanying plans, documents, and supporting data are true and complete to the best of my
knowledge.
further certify that the property owner, if different from the applicant, and the appropriate DFP Regional
Office were sent a complete copy of this Request (including all appropriate documentation)
simultaneously with the submittal of this Request to the Conservation Commission.
Failure by the applicant to send copies in a timely manner may result in dismissal of the Request for
Determination of Applicability.
Signatures:
I also understand that notification of this Request will be placed in a local newspaper at my expense
in azzz;;=
Wetlands Protection Act regulations.
May 27, 2023
___`_� Dale
May 27, 2023
any) Date
wpaforml.doc • rev. 4110/2023 "PA Form 1 - Request for Determination of Appliwbilily • Page 3 of 3