Generic Order Extension to February 2015Important:
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
DEP File Number:
1/1/PA Form 7 - Extension Permit for Orders of Conditions9 b (ol
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
A. General Information
1. Applicar},:
C:-/fiLt
Nemec,
Lo
Maiing Add ss
City/Town
2. Property Owner (if different):
Name
Mailing Address
City/Town
State Zip Code
B. Authorization
Th Ord =rofC
Date
for work at:
n (or Extension Permit) issued to the applicant or property owner listed above on:
Issued by: Conservation Co fission /t ,
Otirkit C. (acres* lit (/d
treet Address Assessor's Map /Pla Nu ber Parcel /Lot Number
recor�d���d at the Registry of Deeds for:
03 re-
Co Y
Certificate (if registered land)
is hereby extended until:
°It1(-18
Book
a°11
Page
to Date th Order wad last extended (if applicable)
This date can be no more than 3 years from the expiration date of the Order of Conditions or the latest
extension. Only unexpired Orders of Conditions or Extension may be extended.
This Extension Permit must be signed by a majority of the Conservation Commission and a copy sent to
the applicant and the appropriate DEP Regional Office (http: / /www. mass. qov /dep /about/region /findvour.htm)
Signatu
//4d
wpaform7.doo • rev. 3/1/2010 Page 1 of 2