36_-251_letterAC 21 Maple Ridge Rd- notice of intent310 CMR 10.99
Form 3
.NE COPIES OF THIS FORM, COMPLETE
------------------------
"TH PLANS, TO CONSERVATION COMMISSION
0 COMPLETE COPIES TO DEP, SPRINGFIELD
DFS' Erik No.
246-
(16 be pro-kiod b7 DM
Gty/rown Northampton
Applicant
Coaoonveal th ^ Ae 7,P-%
/
of Xassachusetts 3 p �� S1 Department of
Defense
Notice of Intent Un-fted states.
of America
Under the
Massachusetts Wetlands Protection Act, G.L. c. 131,. $470
and
Application for a Department of the Army permit
& NORTHAMPTON WETLANDS PROTECTION ORDINANCE
Part 1: General Information �p�•Zr,1 ��PL E jD
1. Location: Street Address_ 407-Wg� o /% .,qA7/
Assessor's MapTD-M 3& L 251
2. Project: Type_IKE5)DEULE'Description COiU TjeVGTJd� p,c S/w6
pP
A) E G F . g i/ 11/.
3. Registry: County Ham shire cu=rent Book_�'S
s Page
Certificate n(it Registered Land)
4. Applicant_ ri4 L) j_ /� L j lea Tel
Address -00
5 . Property Owner L OJe E/V G E' Si9YJiLJc�i S , ff"I'V G Tel . S8 7 / 7.3,5
Addres sJ�7�ieElf 7- . %GQZ- EiU GE
6. Representative- j�f E.5 /� �/2�q �'� P I=-- - Tel. 527 - SZ 90
Address�g 6G E/yDX�L �" ST �/1i.STiy/9!1l/�TGvt.% /'yJ4 O/OZ] .
,7. a. Have the Conservation Commission and the Department's Regional Office each
been sent, by certified mail or hand deliver, 2 copies of completed Notice -of
Intent, with supporting plans and documents?
Yes No ❑ (9 COPIES TO CONSERVATION COMMISSION)
b. Has the fee been submitted? Yea .4 No ❑
c. Total Filing Fee Submitted Iz �•i�
d. city/Town Share of FilingFe-= State Share of Filing Fe //Z -�d
(sent to City/Toon) (34 of fee in excess of 225, sent to DEP)
•.e. Is a brief statement attached indicating how the applicant calculated the
fee? X Yes ❑ No
P. PurmiL rucjuested under: Mass. Wetlands Protection Act (310 CMR 10)
Northampton Wetlands Protection Ordinance:
Effective 11/20/92 3-1 E5 -