HomeMy WebLinkAboutOriginal Signature PagetV�a0V*a%V UOWLL, DUFO rtmV" L of 11v11onme" W
bureau of Resource ProteGtion Wetlands
l Protection
IVIJA I orm 3 -Notice of Intend
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Provided by MassDEP:
I)assDEP File Number
Doi me Transaction Number
Yarmouth
Gityffown
F, Signatures and Submittal Requirements
i hereby certify under the penalties of penury that the foregoing Notice of Intent and accompanying
puns, documents, and supporting data are true and complete to the best of my knowledge_ I understand
that the Conservation Commission will place notification of this Notice in a local newspaper at the
expense of the applicant in accordance with the wetlands regulations, 310 CIVIR 1 q.05(5)(a).
1 further certify under penalfies of perjury that all abutters were notified of this application, pursuant to the
requirements of M.G.L. c.131, § 40. Notice must be made by Certificate of Mailing or in writing by hand
delivery or certified mail (return receipt requested) to all abutters within 100 feet of the property line of the
project location.
2. Dade
3: Signature�'af Property owner of ai"r�erar�t�
5. Signature of Represer�#ative cif any}
For Conservation Commission:
Two copies of the completed Notice of Intent (Form 3), including supporting plans and documents,
two copies of the NO] Wetland Fee Transmittal Form, and the cityltown fee payment, to the
Conservation Commission by certified mail or hand delivery.
For
lll[assDEP:
Cane i
copy of the completed I�lotce of Intent Form 3}= including supporting plans and documents, one
copy of the NCI Wetland Fee Transmittal Farm, and a copy of the state fee payment to the NlassDEP
regional Office (see Instructions} by certified mail or hand delivery.
other:
If the applicant has checked the "yes" box in any part of Section C, Item 3, above, refer to that section
and the Instructions for additional submittal requirements.
The original and copies must be sent simultaneously. Failure by the applicant to send copies in a
timely manner rr�ay result in dismissal of the Notice of Intent.
wpaform3.doc � rev. '121412.�23