414 Conservation Commission 2017 CITY of NORTHAMPTON
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Public Health Inspector-Daniel Wasiuk
Municipal Building-212 Main Street-Northampton.MA 01060 ��p�
? Phone(413)587-1215-Fax(413)587-1221 PublCHealth
a/ '7 http://www.northamptonma.gov245/Health Prevent.Promote.Protect.
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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(ttt)northamptonma.gov
Office of Planning& Development
210 Main Street, Room. 11,City Hall
Northampton, MA 01060
Property Owner: MG. D
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Address: 414 Cede`% Mer C cis)
Engineer: ALt )PISS// //�'
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Conservation Preservation and Land Use Planner
Date:
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212 Main Street,Northampton,MA 01060N 4/ w
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Ph(413)587-1214 Fax(413)587-1221