HomeMy WebLinkAboutRDA 3.17.1999310 CHR 10.99
Form 1
Commonwealth
of Massachusetts
YARMOUTH CONSERVATION COMMISSION
=MAR999
RECEIVED
DW Pas Nu
fro be ptavided by DES
aq/ra YARMOUTH
ApF i®t 2 1 e M L= (2 M A A/
Request for a Determination of Applicability
Massachusetts Wetlands Protection Act, G.L c.131, §40
and the Town of Yarmouth Wetland Bylaw.
1. I, the undersigned, hereby request that the TOWN OF YARMOUTH
Conservation Ccmmiae;on make a determination as to whether the area,
described below, or work to be performed on said area, also described below,
is subject to the jurisdiction of the wetlands Protection Act, C.L. c. 131,
S40.
2. The area is described as follows. (use maps or plans, if necessary, to
provide a description and the location of the area subject to this request.)
Location: street Address
Lot Number: �/ S
3. The work in said area is described below. (Use additional paper, if
necessary, to describe the proposed work.)
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SLC ��rLC(�c� SCbtcl�
1-1
Effective 12/10/89
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4. The owner(s) of the area, if not the person making this request, has been
given written notification of this request on ,(date)
The name(s) and address(es) of the owner(s): Vk'vlot3 2iVVIMc'MANJ
lam. Yw2.+,.
5. I have filed a complete copy of this request with the appropriate regional
office of the Massachusetts Department of Environmental Protection
4/4w (date)
DEP Northeast Regional Office
10 Commerce way
Woburn, MA 01801
DEP Central Regional Office
75 Grove Street
worre3ter, HA 01605
DEP Southeast Regional Office
20 Riverside Drive
Route 105
Lakeville, HA 02347
DEP Western Regional Office
State House West, 4th Floor
436 Dwight Street
Springfield, MA 01103
6, 1 understand that notification of this request will be placed in a local
newspaper at my expense in accordance with Section 10.5(3)(b) 1 of the
regulations by the Conservation commission and that I will be billed
accordingly.
Signature 4YVj Name M IIAIG I21181r R111,62
Address Tel. V4Z-6y'5
1-2
PLOT PLAN
FOR LOT #
Indicate location of garage or accessory building
Additions with dashed lines --------------------
Sewerage disposal (cesspool) ED
Well LZ _
(lot................ft. rear)
AbuttorIs
Name
Lot #
If this is a
corner lot,
write in name
of street.
w
b
5A
E
i
lU 4.cxL.A-0
SIDE YARD
0---- FT—
4 ��p,
_ Cr6110)
HOUSE
SET BACK
......i .ft.
1
.Q.
(lot..................ft. frontage)
(NAME OF STREET)
Information
Supplied by
DE YARD
FT r�
Y
Abuttor's
Name
Lot #
If this i
corner lc
write in
name of
other
street.
MARK NORTH POINT
I
1
LEWIS BAY
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