Admin Review 1.9.24 F`O�7:04
CONSERVATION
C bdirienzo@yarmouth.ma.us
= Yarmouth Conservation Commission OFFICE
Administrative Review
Applicant Information: /\I ,_
Name: k4 c / v`. e a
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Mailing Address: L� 'p^v l�j'�((10✓� �J�`!(L� p��v`-t Y��f,,,p,z`)L .,�
Phone: ?� I .- CJ , I 5 Email: r5L.tVO(,a ASSz.f•A-Vess.cc.M
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 regardingD this Administrative Review form. `�('
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Property/Location of Work: 1 1 L�.�C•^ C� �\rL�� I�� ~�� -
_ Street Name and Number
Signature: ItA /�i�)C�``- I ,[�
Detailed Description and Reasonlfor Proposed Work: ` CCsL'`+ re Cx t l T� woo. ( k rjaa5
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Closest Distance to Resource Area: 1'G? Q r W et S-{-e` BCJ0Q._.
Proposed Start Date:
Company to do Work:
Name:
Address:
Phone: Email:
Administrative Approval:
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This approval is valid for one year. This Approval does not grant any property rights 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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