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'`i DEPARTMENT
' OF
COMMUNITY
0 , y� DEVELOPMENT
'" MATT,, pi �,
oaco TOWN OF YARMOUTH
CONSERVATION COMMISSION
Acknowledgment of Receipt
I, of
(Name) (Business/Company)
have received the following document(s) via hand delivery on this
day of )2C(2,M 202-3 at `, pm0.
• Original Plan to be Copied and Returned SE83 -
• Order of Conditions SE83 -
• Extension Permits SE83-
• Certificate of Compliance SE83-
• ORAD SE83-
• Determination of Applicability t\C k.i) 'C( C'�
(Street Address, Owners Name)
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