HomeMy WebLinkAbout- Permits #242-1641 - 100 GREAT POND ROAD 12/12/2018 Massachusetts Department of Environmental Protection
DEP File Number:
ILI Bureau of Resource Protection -Wetlands
PA Form 7 — (Extension Permit for Orders of Conditions 242-1641...... I
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
f,
A. General Information
Important:
When filling out 1. Applicant:
n
forms on the John Niceforo
computer, use
Name
only the tab
key to move 100 Great Pond Road _ _....
your cursor- Mailing Address
do not use the North Andover MA 01845
return key. City/Town State Zip Code
Q2. Property Owner(if different): �
Name ;
Mailing Address
1
Cityrrown state Zip Code
B. Authorization
The Order of Conditions (or Extension Permit) issued to the applicant or property owner listed above on:
01/15/2015 issued by: Town of Forth Andover
......
Date Conservation Commission
100 Great Pond Road 96 3
for work at: ......__
Street Address Assessor's Map/Plat Number Parcel/Lot Number
recorded at the Registry of'Deeds for:
County Book Page
a
Certificate(if registered land)
is hereby extended until: .-01/15/2020 01/15/2019
Date Date the order was last extended(If applicable)
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. �
This Extension Permit must be signed by a majority of the Conservation Commission and a copy sent to
the applicant and the appropriate DEP Regional Office
(htt ://rnnr w.mass. ov/eea/a enicies/mas a /about/contacts/find-thee-massde -re ional-office-for- our-cit -or-
towrn.html).
Signatures: 12/12/2.018.
Date
i
1
wpaforW.doc•rev.6/2912014 Page 1 of 2
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ILIMassachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection - Wetlands
W PA —Form 7 Extension Permit for Orders of Conditions 242-1641
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 ProVi��d 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 this page and submit it to the Conservation Commission prior to the expiration of the Order of
Conditions subject to this Extension Permit.
To:
Conservation Commission
Please be advised that the Extension Permit to the Order of Conditions for the project at:
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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