HomeMy WebLinkAbout3 Powers Site Access Authorization Form Yarmouth Conservation Commission • 1146 Route 28 • South Yarmouth, MA 02664-4492
Tel. (508)-398-2231 Ext. 1288 • Fax (508)-398-0836 • TTD# (508) 398-2231
Site Access Authorization Form
General Information:
If the applicant is not the property owner, please submit this form with your application. The owner
must be sent a copy of the application on the same day it is filed with this office.
Property Address: _____________________________________________________________
Assessors Map/Lot: _____________________________________________________________
I (we) hereby authorize the individual members of the Yarmouth Conservation Commission and its
agents to enter upon the referenced property for the purpose of gathering information regarding the
application filed with the Commission pursuant to the Wetlands Protection Act (M.G.L. Ch. 131, s.
40) and/or the Yarmouth Wetlands Protection Bylaw (Chapter 143).
Authorized Signature: _______________________________________ Date: ______________
Please Print Name: _________________________________________
If other than owner, please state whether tenant, agent, or other: _____________________
Mailing Address: ________________________________________________
________________________________________________
________________________________________________
Phone: __________________________ Cell: __________________________
Email: __________________________ Fax: __________________________
DEPARTMENT
OF
CONSERVATION
3 Powers Lane West Yarmouth MA 02673
Avner Schneur
September 12 2024
781 312 8637
aschneur@gmail.com
3 Powers Lane West Yarmouth MA 02673
Map 14 Parcel 71