Conservation Commission Regular Meeting Materials (linked)

TOWN OF WATERFORD
Application for Inland Wetland / Watercourse Permit
Type of Application: Agency Use: 5 [20]22
Permitted Use, Section 4.1 Date Received:
Unregulated Activities, Section 4.2 Received By:
Regulated Activities, Section 6 Fee: Application Number:
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1, Applicant: Brinn Ww. Flanethy ( Parks Phone: 960 -4uyH 5g 3 )
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Address: 15 Ru Pe Fers Y R Fi State: LT Zip: 063% 5
rx: 960-440-5717 Email; b Fla heck y @ wader Foclot. dt gs
2. Owner: ty Wa af War bee Ford Phone: $60- 4HHu- 5934
Address: 15 Ro pe Fere y B f State: YT zip: O 6 33 5
rx: 960-7 Y4Y4~ 0473 pmet Pbrvlt a wate Fiedok, wy
3. Agent: Phone: .
Address; State: Zip:
Fax: E-Mail:
4. Property Address: $ ©! Vave hall Ghetd Exdivdiaw
5. Abutting Property Owners — Complete Attached Form
6. Activity to be Reviewed and / or Licensed (attach sheet if necessary): Vv av tnvuls ze { Fo vt a ify &
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(worden } ovis 5 hream [ Plerse See Atiachmerta ).
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7, Description of Proposed Activity (atfach sheet if necessary):
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8, Purpose of Activity (attach sheet if necessary): J AaLreA — ils 2).
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Sa. Acreage of Property: LAS 9b, Acreage of Wetlands: INS zi
10. Acreage of Wetlands Altered: MAY 2.0 2022
Planning & Development
11. Wetland Mitigation Proposed:
Town of waterford; et
12. Section 7 and sections 8.1 & 8.2 of the Town of Waterford “Inland Wetlands and Watercourse Regulations” —ya Sel
have been complied with: (Review attached check list) Yes: No:
The applicant / owner hereby gives the Commission, its agent and consultants the right of free access to any
part of the property under consideration. The undersigned warrants the truth of all statements contained
herein and in all supporting documents according to the best of his / her knowledge, information and belief.
Applicant: / a Vv Foo Date: 5 l ig fan
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Owner: Date:
Agent: Date:
IWW Permit Application form
Updated 3 2011