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} CONSERVATION
OFFICE
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Yarmouth Conservation Commission
Administrative Review
Applicant Information: r� /� /�/
Name: V f iT c'n P C-i✓� �� C��9� Dog g Lam.
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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. rt )
Property/Location of Work:6'Oca ` 77 7 c 567 (-t L• ® 6a� =i"e_--{�-�- Laf3 1)
Street Name and Number
Number
Signature: V 1� �l / l7 iC`le s SSDC.
Detailed Description and Reason for Proposed Work:PLC
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Closest Distance to Resource Area: Po—GC C d S ti L
Proposed Start Date:S R—M)C c}/1?7,f E� O t 7-}-S Z-'VAC tfV`,VS l�
Company to do Work:
Name:f-fiifn GOPJ�12�S bi- Gf�L l� �S" t1 � G -.O
Address: V [TV GT
Phone: S ") a OU E Email:
Administrative Approval:
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This approval is valid for one year. This Approval does not grant any prope ''tits 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
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