HomeMy WebLinkAboutBURKE, ROBERT (2) Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 7 — Extension Permit for Orders of Conditions 242-1261
Provided b DEP
Massa
Massachusetts Wetlands Protection Act M.G.L.MGLc. 131 40
A. General Information
Important:
When filling out 1. Applicant:
forms on the John Burke
computer, use Name
only the tab
key to move 71 Sutton Hill Road
your cursor- Mailing Address
do not use the North Andover MA 01845
return key. City/Town State Zip Code
2. Property Owner(if different):
Robert Burke, Estates of Robert J. Burke
Name
14 Chickering Road
Mailing Address
North Andover MA 01845
City/Town State Zip Code
B. Authorization
The Order of Conditions (or Extension Permit) issued to the applicant or property owner listed above on:
1/12/05
Date
for work at:
Cotuit Street& Leyden Street Map 47 Lot 26
Street Address Assessor's Map/Plat Number Parcel/Lot Number
recorded at the Registry of Deeds for:
Essex North Document#19154
County Book Page
Certificate(if registered land)
is hereby extended until:
1/12/09
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:
North Andover �7/Q 7
Conservation Commission Date
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number.
WPA Form 7 — Extension Permit for Orders of Conditions 242-1261
Massachusetts Provided by DEP
Wetlands Protection
Act M.G.L. c. 131 40
B. Authorization (cont.)
This Order of Conditions Extension must be signed by majority of the Conservation Commission
and a copy sent to the applicant and the appropriate DEP Regional Office(see
http://www.mass.gov/der)/about/region/findyour.htm).
Signatures:
-WZ ,
Notary Acknowledgement
Commonwealth of Massachusetts County of Essex North
On this b � of 1 Q,CI� crt' adf?
Day Month I Year
Before me, the undersigned Notary Public, personally appeared
Name of Signer
proved to me through satisfactory evidence of identification, which was/were
Massachusetts License
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 North Andover Conservation Commission
Cityrrown
DONNA M.WEDGE Agnre of Notary Public 01
NOTARY PUBLIC 7�
p pP.;MONWEAITH OF MASSACHUSETTS
MY Comm.Expires Aug.7,2W9 Printed Name of Notary Public
1
Place notary seal and/or any stamp above My /7 �U0
Com isslo Expires(Date)
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a
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
L-I
WPA Form 7 -- Extension Permit for Orders of Conditions 242-1261
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
C. Recording Confirmation
The applicant shall record this document in accordance with General Condition 8 of the Order of
Conditions (see below), complete the form attached to this Extension Permit, have it stamped by the
Registry of Deeds, and return it to the Conservation Commission.
Note: General Condition 8 of the Order of Conditions requires the applicant, prior to commencement of
work, to record the final Order(or in this case, the Extension Permit for the Order of Conditions) in the
Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of
the affected property. In the case of recorded land, it shall be noted in the Registry's Granter Index under
the name of the owner of the land upon which the proposed work is to be done. In the case of registered
land, it shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the
proposed work is done.
Detach page 3 of Form 7 and submit it to the Conservation Commission prior to the expiration of the
Order of Conditions subject to this Extension Permit.
To:
North Andover
Conservation Commission
Please be advised that the Extension Permit to the Order of Conditions for the project at:
Cotuit Street& Leyden Street 242-1261
Project Location DEP File Number
has been recorded at the Registry of Deeds of:
County
for:
Property Owner
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:
Date Book Page
If recorded land the instrument number which identifies this transaction is:
Instrument Number
If registered land, the document number which identifies this transaction is:
Document Number
Signature of Applicant
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