HomeMy WebLinkAbout- Permits - 997 DALE STREET 5/2/2019 11
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APPLICATION FOR 3 - AY EXTENSION ER
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Pursuant to the provMlons of M.G.L. c 3 1, s. 80A and 321 CMR 2.08,1 hereby apply�for a 30,day
extensi*on permit tio confinueto alleviatean exisfing threat threatto huma .health and sa f6tyas determined
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Agent Nrn (ifapplicable): /�51151
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Complaint Location, differ than above,):
Type Complaint: Please provide a detailed description of the threat public health, and safety.
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'Under M.G.L.c. 1 1 s. 80A, an extension permit authorizes tne applicant or his duly au o6zedagent t
remedy the threat to human health and safety by one or more of the following options; the use of
conibear orbox or cage-type traps -, the king of beaver or inuskrat, subject t .regulations; (b)the
breaching of dams, dikes, bogs or berm&- and/or(c) employing any non-lethal management of water-flow
devices,
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Applicant
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B r f Health Official Signature:
J,1I Please attach a copy of the Board of Hea(th site visit r port " l a copy of the
d emergency a i se forms. If options B and/or C employed, at� c
copy of the Emet-gency Certification from the Conservation Commi si"on..