308 Conservation Commission 2016 BOARD OF HEALTHa*ya.n"
CITY OF NORTHAMPTON �� s
DONNA C.SALLOOM,CHAIR 60
SUZANNE SMITH,MD. MASSACHUSETTS 010
er!
Vio
JOANNE LEVIN,M.D. I r� 4
aryl /
lc.
OFFICE OF THE :ii.�:
Benjamin siuk,Wood,MPH,Director
BOARD OF HEALTH
Emath,Health Inspector 212 MAIN STREET
Edmunda SHeallh InealthtNr (413)4 587) 87- 16
Patricia Abbott,RN,Public Health Nurse FAX(413)56]-1221 NORTHAMPTON,MA 01060
Heather McBride,Clerk
Onsite Septic System Construction Permit: Conservation Commission Review
NOTE: As of 1/1/11, Septic System Permits will not be issued by the Northampton Health Department
until we receive this form signed by the Northampton Conservation Commission Staff Member.
The Conservation Commission can be reached by contacting:
0 Sarah LaValley,Conservation, Preservation and Land Use Planner
SLaValley@northamptonma.gov
587-1263
Office of Planning& Development
210 Main Street, Rm. 11,City Hall
Northampton, MA01060
1 I q
Property Owner: g�rtc1< MP/urcc �r Address: Lai—A ( r
308 C_ esk-Pe d
Engineer: J jt-r, Mca t Nuts Rid
ire tight i1/414e. 04&cJlin MtderL)
Co -ervation ission Conservation, Preservation and Land Use Planner
Date: Sibillo t
tOe
1 S a V O&k, but- ridtP,t3 'fit k,214
u�9�12