Admin review 1.17.2024 f•Y
kt,4 CONSERVATION
s' OFFICE
bdirienzo@varmouth.ma.us
= Yarmouth Conservation Commission
Administrative Review
Applicant Information:
Name: •O ,) cJ NIP/
Mailing Address: I 1 " 1 Y OtJJYu 9a-}�\ 2J�—}
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Phone: 508. 36a`- 99 a Email: 30\ 11C6YeY' ne1
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.
Property/location of Work: a°i g w QAJI. Sd°(�O'.
,/�� Streett Name and Number
Signature: I I11.(`AtO,29 D 01.A )1:�AQQNL (�
Detailed Description and Reason(�� for Proposed Work: 0 9JY1'., .AA Af1.�V1ll'�C{2 •
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Closest Distance to Resource Area: S 3.
Proposed Start Date: LknOtrUYVKAYA
Company to do Work: p
Name: ' 4-crolf -X IMF n- fff)
Address: 1 I�5t"
Phone: 50'6 36D- a Li Email: JO\ ver rzon,ne,1
Administrative Approval: Y Mkc1
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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