25A-166 Massachusetts Department of Environmental Protection DEP File Number:
• Bureau of Resource Protection - Wetlands
WPA Form 7 — Extension Permit for Orders of Conditions 246-509
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
B. Authorization (cont.)
This Order of Conditions Extension must be signed by a majority of the Conservation Commission
and a copy sent to the applicant and the appropriate DEP Regional Office.
Signatures:
4 °
Notary Acknowledgement
Commonwealth of Massachusetts County of -UAIWarr`
On this °W-K of —�VL)
Day Month Year
Before me, the undersigned Notary Public, personally appeared
1t}icbw S1t 12.
Name of qigner
proved to me through satisfactory evidence of identification, which was/were
Description of evidence of identification
to be the person whose name is signed on the preceding or attached document, and acknowledged to
me that he/she signed it voluntarily'for its stated purpose.
As member of 'City/Town Conservatiop%@ S�Ejpion
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v
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Signature of Notary Public
Printed Name of Notaply Public
Place notary seal and/or any stamp above My Commission Expires(Date)
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i
,u Massachusetts Department of Environmental Protection
• Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 7 — Extension Permit for Orders of Conditions 246-509
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
A. General Information
Important:
When filling out 1. Applicant:
forms the
computer, use City of Northampton Office of Planning and Development
Name
only the tab
key to move 210 Main Street
your cursor- Mailing Address
do not use the Northampton MA 01060
return key. City/Town State Zip Code
,Q 2. Property Owner(if different).-
Name
enen
Mailing Address
City/Town State Zip Code
B. Authorization
The Order of Conditions (or Extension Permit) issued to the applicant or property owner listed above on:
08/29/2002
Date
for work at:
between Damon Road and Woodmont Road _ 25A 166 and 167
Street Address Assessor's Map/Plat Number Parcel/Lot Number
recorded at the Registry of Deeds for:
Hampshire _ 2546 132
County Book Page
Certificate(if registered land)
is hereby extended until:
July 28, 2008
Date
This date can be no more than 3 years from the expiration date of the Order of Conditions or the latest
extension. Only unexpired Orders of Conditions or Extension may be extended.
Date the Order was last extended (if applicable):
Date
Issued by:
Northampton July 28, 2005
Conservation Commission Date
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