44-012 order of conditions extensionHAMPSHIRE
REGISTRY OF DEEDS
DOCUMENT
COVER SHEET
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from original document takes precedence
when indexing data into Registry system.
THIS IS THE FIRST PAGE OF THIS DOCUMENT-DO NOT REMOVE
PROPERTY ADDRESS: 01V WIGSdI1/41 RJ
DOCUMENT TYPE: OM. O offorois £arivsr
NAME .REFERENCE:
Uoi,s 6-
Recorded: 10/13/2009 11:57 AM
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Massachusetts. Department of Environmental Protection
Bureau of Resource Protection Wetlands
WPA Form 7 Extension Permit for Orders of Conditions 246 -591
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
A. General Information
1. Applicant:
John Ewing
Name
297 Old Wilson Road
Mailing Address
Northampton
City/Town
2. Property Owner (if different):
Name
Mailing Address
City /Town
B. Authorization
The Order of Conditions (or Extension Permit) issued to the applicant or property owner listed above on:
09/05/2006
Date
for work at:
Old Wilson Road 44 012
Street Address Assessor's Map /Plat Number
recorded at the Registry of Deeds for:
Hampshire 4807 110
County Book Page
Certificate (if registered land)
is hereby extended until:
08/27/2012
Date
This date can be no more than 3 years from the
extension. Only unexpired Orders of Conditions
Date the Order was last extended (if applicable):
Issued by:
Northampton
Conservation Commission
expiration. date of the Order of Conditions or the latest
or Extension may be extended.
N/A
Date
08/27/2009
Date
MA
State
State
DEP File Number:
01062
Zip Code
Zip Code
Parcel /Lot Number
wpaform7.doc rev. 1/07 Page 1 of 3
'Y
wpaform7.doc rev. 1/07
Massachusetts Department of Environmental Protection
Bureau of Resource Protection Wetlands
WPA Form 7 Extension Permit for Orders of Conditions 2f6 5 c li
Massachusetts Wetlands Protection Act M G.L,. c. 131, §40
B. Authorization (cont.)
This Order of Conditions Extension must be. signed by a majority of the Conservation Commission and
a copy sent to the applicant and the appropriate DEP Regional Office (see
http: /www.mass.gov /dep /about /region /findyoUrhtm).
Notary Acknowledgement
Commonwealth of Massachusetts County of,
On this
Name of Signer
As member of
2
Day
271
1
Before me, the undersigned Notary Public, personally appeared
proved to me through satisfactory evidence of identification, which was /were
4461.314, 14
Description of evidence of identification
to be the person whose name is signed on_the preceding or attached document, and acknowledged to
me that he /she signed it voluntarily for�itsstated purpose.
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Place notary seal and /or any stamp above
bf
City/Town
Signatur= of Notary P
Month
Printed Name of Notary Public
4 My Co mission Expir (Date)
ATTEST: HAMPSHIRE, ✓lagia�+r�. CXto.,REGISTER
MARIANP]E L. DONOHUE
Year
DEP File Number:
Provided by DEP
Conservation Commission
Page 2 of 3