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01.•Y DEPARTMENT
4C OF
,' COMMUNITY
O y; DEVELOPMENT
MATTA M S
eiS) 0 ",„ TOWN OF YARMOUTH
CONSERVATION COMMISSION
Acknowledgment of Receipt
I, 'D-�i\i\v5 A-C-e-k- of
(Name) (Business/Company)
have received the following document(s) via hand delivery on this
II day of DeCY\ )tf 2023 at 0 : C)A pm . i.
• Original Plan to be Copied and Returned SE83 -
• Order of Conditions SE83 -
• Extension Permits SE83-
22-\ (0 Mg \-J (\c�� �c\
. Certificate of Compliance SE83-
♦ ORAD SE83-
• Determination of Applicability
(Street Address,Owners Name)
(IN
:....( T ,Jv'
'
Signature
Yarmouth Conservation Commission • 1146 Route 28 • South Yarmouth, MA 02664-4492
Tel. (508)-398-2231 Ext. 1288 • Fax(508)-398-0836 • TTD# (508) 398-2231