CCI02232022Planning & Sustainability • City of Northampton
planning ( resiliency I conservation I place -making I sustainable transportation I zoning I GIS I historic I CB architecture I agriculture and food
413-587-1262
WAIVER/EXTENSION REQUEST
Please complete this form, sign at the bottom and return email to the address indicated above
Date:
1, ` \e , tsLu ud (wetASS 0 L., hereby waive the time period requirement for a public
Name of App ' nt or Representative J
hearing / meeting following receipt of my filing of;
Notice of Intent
0 Request for Determination of Applicability
❑ Other by the Northampton
Conservation Commission under Massachusetts General Laws, Ch. 131, sec. 40 and its Regulations,
and/or Northampton Wetlands Ordinance, C 337 of the Northampton Code.
The request was submitted on: 2r,2,`2_- for work at: RivevOY cal*.
Date Filed Location / Address of where work will be done
I am the: V Applicant
❑ Property Owner
❑ Applicant's Representative
C%<kCeri $ v.; vt) A&s o e .
(Signature)
(Date)