HomeMy WebLinkAboutSite Access Form - 30 Moss Road (10.17.24) 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: ___30 Moss Road_________________________________________________
Assessors Map/Lot: ___Map 14 / Parcel 112 / Lot 57____________________________________
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: ___10/17/2024__
Please Print Name: ___Michael Fraher______________________________________
If other than owner, please state whether tenant, agent, or other: _____________________
Mailing Address: _94 I Street Boston, MA 02127_________________________________
________________________________________________
________________________________________________
Phone: __508-685-8688______________ Cell: __________________________
Email: __mpfraher@gmail.com_____________________ Fax: __________________________
DEPARTMENT
OF
CONSERVATION