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Get MA DEP Request for Departmental Action Fee 2011

Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number Request for Departmental Action Fee Transmittal Form Provided by DEP A. Request Information 1. Location of Project a* Street Address c* Check number Important When filling out forms on the computer use only the tab key to move your cursor - do not use the return key. b. City/Town Zip d. Fee amount 2. Person or party making request if appropriate name the citizen group s representative Name Mailing Address City/Town Phone Number State Zip Code Fax Number if applicable Applicant as shown on Notice of Intent Form 3 Abbreviated Notice of Resource Area Delineation Form 4A or Request for Determination of Applicability Form 1 B. Instructions 1. When the Departmental action request is for check one Superseding Order of Conditions Superseding Determination of Applicability Send this form and check or money order for 100. 00 single family house projects or 200 all other projects payable to the Commonwealth of Massachusetts to Department of Environmental Protection Box 4062 Boston MA 02211 feeform*doc rev* 10. 17. 11 2. On a separate sheet attached to this form state clearly and concisely the objections to the Determination or Order which is being appealed* To the extent that the Determination or Order is based on a municipal bylaw and not on the Massachusetts Wetlands Protection Act or regulations the Department has no appellate jurisdiction* 3. Send a copy of this form and a copy of the check or money order with the Request for a Regional Office. 4. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. Request Information 1. Location of Project a* Street Address c* Check number Important When filling out forms on the computer use only the tab key to move your cursor - do not use the return key. b. City/Town Zip d. Fee amount 2. Person or party making request if appropriate name the citizen group s representative Name Mailing Address City/Town Phone Number State Zip Code Fax Number if applicable Applicant as shown on Notice of Intent Form 3 Abbreviated Notice of Resource Area Delineation Form 4A or Request for Determination of Applicability Form 1 B. b. City/Town Zip d. Fee amount 2. Person or party making request if appropriate name the citizen group s representative Name Mailing Address City/Town Phone Number State Zip Code Fax Number if applicable Applicant as shown on Notice of Intent Form 3 Abbreviated Notice of Resource Area Delineation Form 4A or Request for Determination of Applicability Form 1 B. Instructions 1. When the Departmental action request is for check one Superseding Order of Conditions Superseding Determination of Applicability Send this form and check or money order for 100. Instructions 1. When the Departmental action request is for check one Superseding Order of Conditions Superseding Determination of Applicability Send this form and check or money order for 100. 00 single family house projects or 200 all other projects payable to the Commonwealth of Massachusetts to Department of Environmental Protection Box 4062 Boston MA 02211 feeform*doc rev* 10. .

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