HomeMy WebLinkAboutAdmin Review 3.18.24 2 of qR'o CONSERVATION
g, Ly OFFICE
bdirienzo@varmouth.ma.us
Yarmouth Conservation Commission
Administrative Review
Applicant Information:311
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Name: ��de/1i //1 (,0 L -j 5 / P
Mailing Address: ((��
Phone: �6D '� d b 0tt Email: .r �, U vnr-sey...,
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: 3 C A„"U 1,,Lok, L.)C.S'+ (w'YYov M A-
t t Nam nd Number
Signature: {� 11
Detailed Description and Reason for Proposed Work: 1/i 5 C!U f j%4. 5 �107.) Yc K, A
0'4^ k S11)i^c_ Yrlr OGr� r�1C/ �055 /7��
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°1.kv C e,v2 .t 4-C<c(c 5 T I-5 h t c c 5 5 i✓c/ .
Closest Distance to Resource Area: ! (O dGI 2 v y c. l E b 1,44 k
Proposed Start Date: l�/� Sp b l-1^f
r ...: TO'„ass> z�W :. ..
fd�t t+i�AYvii�-W� ' ... .,
Company to do Work:
Name:
Address:
Phone: Email:
Administrative Approval:
68
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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
Name:
Date:
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