HomeMy WebLinkAboutComplaints - 42 CROSSBOW LANE 5/17/2018 • Town of Northn oar r
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f / Health Department
1.20 Main Street
North Andover, MA 01845
Telephone (978) 983-8655 Fax (978) 983-8988
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Brian J. LaGrasse, Director of Public Health
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Complaint Form
Complaint Number: c / Date: .f /p
Location of Complaint: /' /" �a�.� CDS Type:
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Property towner: ��° � , � Phan:
Name of Complaintant: /`` �' �'° / Phone:
Address:
Complaint:
Date: Report Attached: Yes No
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Findings: fj
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Inspectors yig,nature: ,,._.._. . Date Inspected: ')/9
Date Closed: ,)/
APPLICATION FOR 10-DAY EMERGENCY BEAVER OR MUS BRAT PERMIT
TO 13E FILLED OUT BY APPLICANT Fee (if applicable): $
Name:
L L t 2 A–.r G- (t(r i Date
Address:
Town: -o-kr IbNC��l.;.• "Lip Code:.._
Daytime Tel. it � '`�zl ;C: l �.� Evening Tel. # elD
Agent Name: Tel. # _----- 1 %
(if applicable) — �,V
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Complaint Location:
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Is the problem entirely on your property? Yes: l-, No: Don't Know:—
Note:
now:Note: If the problem does not occur entirely on the applicant's property, consent
forms from all other property owners must be obtained.
Type of Complaint: Provide a detailed description of the perceived threat to public health and.
safety
Under M.G.L. c. 131, s. 80A, an emergency permit authorizes the applicant or his duly authorized agent
to immediately remedy the threat to human health and safcty by one or more of the following options: (a)
the use of conibear or box or cage-type traps for the taking of beaver or muskrat, subject to regulations;
(b)the breaching of dams, dikes,bogs or berms; and/or(c)employing any non-lethal management of
water-flow devices. The emergency permit will be good for 't0 days from the date of issue.
Signature of Applicant: ✓ Date: V
NOTE: Options (b) and/or(c)above require applicant to get conservation commission approval prior to
such work in accordance with the wetlands protection act.