625 Conservation Commission 2018 � n'°vCITY of NORTHAMPTON ¢
. 1 PUBLIC HEALTH DEPARTMENT
��� f �A. � Public Health Director-Merridith O'Leary.RS
x�.= Municipal Budding-212 Main Street-Northampton,MA 01060 1 PI
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—""�5 Phone(41 3)587-1215-Far(413)587-1221 PublicHe lth
http://www.northamptonma.gov/245/Health Prevent.Promote.Protect.
Onsite Septic Construction Permit: Conservation
Commission Review
NOTE: As of 1/1/11, septic System Permits will not be issued by the Northampton Board
of Health until we receive this form signed by the Northampton Conservation Commission
Staff member. The conservation Commission can be reached by contacting:
❑ Sarah LaValley Conservation Preservation and Land Use Planner
SLaV alleynnorthamptonma.gov
Office of Planning&Development
210 Main Street, Room. 11, City Hall
Northampton,MA 01060
Property Owner: ! tivWl.4g /�J5 L.f Iit
Address: bac �.Oes1---klw...m.ED -1 -POC.t�
Engineer: ALL) (Je IS s
Cons anon Pr-ation and Land Use Planner
Date: S/i0/P
0 New Construction
)(Repair Construction
212 Main Street,Northampton,MA 01060
Ph(413)587-1214 Fax(413)587-1221