79 Conservation 2017 atH/MpT CITY of NORTHAMPTON
` -•ta, i t PUBLIC HEALTH DEPARTMENT
Public Health Director-Merridith O'Leary,RS
'� "f Municipal Building- 212 Main Street-?4orthampton, MA 01060 Public Phone(413)587-1215--Fax(413)587-1221 PublicHealth
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:
o Sarah LaVallev, Conservation, Preservation and Land Use Planner
SLaValleya4northamptonma.gov
Office of Planning&Development
210 Main Street, Room. 11,City Hall
Northampton, MA 01060
Property Owner: U /(2/1 /t) FOCt.J!/
Address: 5jy mo.v /`��y I•?'L e%. 47-
Engineer: /4/6,4) 4...)e(6 s
Cons: ration rese to: and Land Use Planner
Date: / S 17
o New Construction
XRepair Construction
212 Main Street,Northampton,MA 01060
Ph (413)587-1214 Fax(413)587-1221