46 Application for 10 Day Beaver/Muskrat Permit 2013 APPLICATION FOR 10• AY EMULCENCY BEAVER OR MUSKRAT PERMIT
TO BE FILLED OUT BY APPLICANT Fee(if applicable):$
Name✓o'etp,t)1.1 WA/ k 0 ntawt-o Ansi AS Dc, Date:
Addosamce- .'e_ co, /so 12iwa�i(eaf- -w 14Gr /
Town: Eio. .c P Tap Coda: 0/ D I,-
Daytime Tel.# (LGI9 °)---/ -1 ?
Agent Name:
(rfapplicable) rirkt_ Ca,l(a-4q ..
EveningTel#
Lit WA/ Ala a./
LLe Te1# 01/ 3 Si-%- 6Y73--
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Complaint Lot
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Iv. Dveti-e .., lt%�ly
Is the problem entirely on your property? Yes _rL No:_ Don't Know:___
Note:Elm problem does not ochar cairn ende 's property,consent
forms firm all other empetty owners A be obtained
Type of Cotoriaint Provide a ddadal description of the perceived threarto public health and
safety n
De min, 3 to r, keel c h< ivc.L'{— Z `P-Coocbni
-5-0 Yer'e f h 14.5a-/ /
P�t-. Or..-. ('t. l v/ TD -.Loy ro
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UndaM.t3Lc.1 31,s80A,anemetgeocypunkahttaroestheapplhant orbit dulyauthorizedage t
to immediately remedy the treat to Imam health and safety by one or more of the following options(a)
the use of combos or box a'cage-type taps fa tie taking of beaver at meaner,subject tongelationn
(b)the bad of dams,dikes,bogs or baron andta(c)empb9hB mho`nonlethal management of
water-flow devices the ahhageney pest will be good 1 a 10 days from the dame of iae.
Siguare ofApplk "1, C ae A Dame /3
NOTE:Options(b)and/or(c)above expire appfca tto get amsavatiou commission approval j>o
such wodcin sigh the wetlands Attention act .,