HomeMy WebLinkAbout20240625 RDA Burt 4741 Falmouth Road06/11/2024
wpaform1.doc • rev. //2023 WPA Form 1 – Request for Determination of Applicability • Page 1 of 3
Massachusetts Department of Environmental Protection
Bureau of Water Resources - Wetlands
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Municipality
A.General Information
Important:
When filling out
forms on the
computer, use only
the tab key to move
your cursor - do not
use the return key.
1. Applicant:
First Name Last Name
Address
City/Town State Zip Code
Phone Number Email Address
2. Property Owner (if different from Applicant):
First Name Last Name
Address
City/Town State Zip Code
Phone Number Email Address (if known)
3. Representative (if any)
First Name Last Name
Company Name
Address
City/Town State Zip Code
Phone Number Email Address (if known)
B. Project Description
1. a. Project Location (use maps and plans to identify the location of the area subject to this request):
Street Address City/Town
How to find Latitude
and Longitude Latitude (Decimal Degree Format with 5 digits after decimal
e.g. XX.XXXXX)
Longitude (Decimal Degree Format with 5 digits after
decimal e.g. XX.XXXXX)
and how to convert
to decimal degrees Assessors’ Map Number Assessors’ Lot/Parcel Number
b. Area Description (use additional paper, if necessary):
c. Plan and/or Map Reference(s): (use additional paper if necessary)
Title Date
Title Date
06/10/2024
y
06/10/2024
Property owners actually touching on the subject parcel upon which work is proposed.