04-018 (11) i
310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION
10.99: continued
_ssued by Noi:thampton_Cons_en�ation Commission
Signaature(s)
i
Wh issued by the Conservation Commission this Extension Permit must be signed by a majority of its
members.
On this day of 1 '97 19 ` r , before me personally
appeared �' /''�f�'N �'��''""'' ,to me known to be the person described in, and who
executed,the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and
deed.
Notary Public My Commission Expires
Detach on dotted line and submit to the Northampton Conservation Commission prior to commencement of work.
.........................................................................................................................................................................................................
To Northampton Conservation Commission Issuing Authority
Please be advised that the Extension Permit to the Order of Conditions for the project at
File Number has been recorded at the Hampshire County Registry of Deeds and
has been noted in the chain of title of the affected property in accordance with General Condition 8 of the original Order of
Conditions on --- 19-
If recorded land,the instrument number which identifies this transaction is
If registered land,the document number which identifies this transaction is
-ignature _ Applicant
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310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION
DEP File No. 1246- J`
(To be provided by DEP)
Form 7 1\ 3 1998
Commonwealth City/Town_Northam�ton_—_
of Massachusetts P
Applicant
EXTENSION PERMIT
MASSACHUSETTS WETLANDS PROTECTION ACT, G.L. c. 131, §40
and
THE CITY OF NORTHAMPTON'S WETLAND'S PROTECTION ORDINANCE, Ch.24
From -Northampton onsepmtiosonimission Issuing Authority
TOJ
tee) (Address)
The Order of Conditions (or Extension Permit) issued on �� –f'l ' �y (date)
to /y 7 , for work at �� f Icy ��o/? �(vd� Le ems
(name) (address)
_r is hereby extended for a period of year(s) from the date it expires.
This Extension Permit will expire on 10-- 11 -- ZG U o (date)
This document shall be recorded in accordance with General Condition 8 of the Order of Conditions.
..........................................................................................................................................................................
(Leave Space Blank)
4/1/94 310 CMR- 426 426