HomeMy WebLinkAboutJeff Signed NOI FormMassachusetts Department of Environmental Provided by MassDEP:
Protection MassDEP File #:
1� Bureau of Resource Protection - Wetlands eDEP Transaction #:1697479
WPA Form 3 - Notice of Intent Cityfrown:YARMOUTH
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
E. Fees
Fee Exempt: No Sling fee shall be assessed for projects of any city, town, county, or district of the Commonwealth, federally recognized Indian
tribe housing authority, municipal housing authority, or the Massachusetts Bay Transportation Authority.
Applicants must submit the following information (in addition to pages 1 and 2 of the NOI Wetland Fee Transmittal Form) to confirm fee payment
2. Municipal Check Number 3 Check date
4. State Check Number 5. Cheek date
6. Payer name on check: First Name 7. Payer name on check: Last Name
F. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Notice of Intent and accompanying plans, documents, and supporting data are true
and complete to the best of my knowledge. 1 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, 3l0 CMR 10.05(5)(a).
I further certify under penalties 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 ail abutters within 100 feet
of the property line of the project location.
�I -A')-Z
1. Signa o l 2. Date
3. Signature of Property Owner(if different)
, " �f " eX'41, -
5. Signature of Representative (if any)
For Conservation Commission:
4. Date
August 1, 2024
6, Date
Two copies of the completed Notice of Intent (Forst 3), including supporting plans and documents, two copies of the NOI Wetland Fee Transmittal
Form, and the city.'town fee payment, to the Conservation Commission by certified mail or hand delivery.
For MauDEN
One copy of the completed Notice of intent (Form 3), including supporting plans and documents, one copy of the NOI Wetland Fee Transmittal Form,
and a copy of the state fee payment to the MassDEP Regional Office (see Instructions) by certified mail or hand delivery.
Oth9r:
If the applicant has checked the "yes" box in Section C, Items 1-3. 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 may result in dismissal of the
Notice of Intent.
Page 7 of 7 * ELECTRONIC COPY