7 Commission Review 2017 CITY of NORTHAMPTON
-_04 a PUBLIC HEALTH DEPARTMENT
3#7 j �' �� Public Health Inspector—Daniel Wasiuk
- • Municipal Building—212 Main Street--Northampton,MA 01060 �.y'=
,' Phone(413)587-1215—Fax(413)587-1221 Public Health
http://www.northamptonma.gov/245/Health Prevent. Promote.Protect.
Onsite Septic Construction Permit: Conservation
Commission Review
NOTE: As of 1/1/11, septic System Permits will not be issued by the Northampton Board
of Health until we receive this form signed by the Northampton Conservation Commission
Staff member. The conservation Commission can be reached by contacting:
❑ Sarah LaValley,Conservation. Preservation and Land Use Planner
SLaValley@northamptonma.gov
Office of Planning& Development
210 Main Street, Room. 11,City Hall
Northampton, MA 01060
/ 7
Property Owner: 42' 71.Me e/Address: 7j eeAa 5 /-4//OGv /e0e-c-c( Leec S
Engineer: Akt) Ve/55 /e*--,l' J07res5
(x/�/. / P!�f a i
Conse ation PreservatiTand Land Use Planner
Date: 7/7'1/17
0 New Construction
Repair Construction
212 Main Street,Northampton,MA 01060
Ph(413)587-1214 Fax(413)587-1221