569 Emergency BEaver/Musckrat Permit 2011 Grp - - a 01
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APPLICATION FOR 10-DAY EMERGENCY BEAVER OR MUSKRAT PERMIT VV��
TO BE FILLED OUT BY APPLICANT .-{_ Fee(if applicable): $ kl nz
Name: �IVI �� /� %1-�. (/I" I I--5 / Date: - a�` l/
Address: 5(09 /Verltj / vin' ?tIlaN
Town: 0 )-P!'I CP / / A- Zip Code: Q�-l�(/� 6;" 2
Daytime Tel.# i kt, ^ // (.0 O Evening Tel.# 5IS tP —
Agent Name: ' Tel.#
(if applicable)
Complaint Location:
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Is the problem entirely on your property? Yes:K No:_ Don't Know:_
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
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UnderM.O.L c.131,s 80A,an emergency permit authorizes the applicant or his duly authorized agent UQ-
to immediately remedy the that to human health and safety by one or more of the following options:(a) nCDO
the use of combear or box or cage-type naps for the taking of beaver or mrslaat,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 10 days from the date of issue.
Signature of Applicant:
Date:
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
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