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V: Addlllonat Inform allon lot a Ca;.ar:r-.en o! the r„—.y 'rermlt <br /> 1 . COE Application No. 2. <br /> (to be provided by COE) (Name of waterway) <br /> 3. Names and addresses of property owners adjoining your property: <br /> 4. Document other project alternatives (i.e., other locations and/or construction methods, parti;.u:_-iy,those <br /> that would eliminate the discharge of dredged or fill materia)into waters or wetlands). <br /> 5. 81/." x 11 " drawings in planview and cross-section. showing the resource area and the proposed activ- <br /> ity within the resource area. Drawings must be to scale and should be clear enough for photocopying. <br /> C�fcatihrl is regurgd from the Div on of Water Po'jtiort Cmiroi before the Federal permr, can be ssued. <br /> Cer fcatiorl may be obtai�by ocntacrg the D'n•scn of Water Pollution Control. 1 Wnter Str6et Bcs-cn. <br /> Mass&cnusetts 02108. <br /> Where the activity will take pLaoa vAhi1 the area under t^,e Massae usetis approoad Coastal 'Qrle <br /> Management Program the appicant certifies that his p-0� - miry CaTples wih axi will be ccrpucted <br /> n a manner that is oa*ss�t wivt the aha sol Perm. <br /> Information pro,l will be used irt e✓aluatrc the apprfFzon for a pe:mt and s made a rraner of pibfc <br /> record through issuance of a pubes notice. Dscksure of the i-iformabi is voluntary t�v e er a nezessaty <br /> irdocnta= s not pncvried. ffw_ app<czl)Cn canrot be process&d nor can a p=ermit lr issued. <br /> hereby certify under the pains and penalties of perjury that the foregoing Notice of Intent and accompanying <br /> plans, documents and supporting data are true and complete,to the best of my knowledge. <br /> Signature 01 Applicant <br /> . Date <br /> Z�_ iL -- <br /> Sign ture of Applicant's Representative Date <br /> HFD <br /> FORM 100 (TEST)-E.L.Dc.n t. tKG 9cry 43.6 •ri•e•.0 by HQP5ACE. f V, 19!:". <br /> 1 MAY 82 —rn . aera.nl .en1..n. . ry ni cep. .menti enbr A,e, nt s,ar e! Y..... <br /> b...1t. ep;t,rni iu. <br /> !or . pnm11 1a e..nn Der v......e tic p.r7vv anl.in r. b. V. .,,e scan ..1.r. 7n. Off,v <br /> er N.....menti .nC bed". WYE! L.. .ppm•.1 1Ao.. ....l.c nr rrc c..rC !• t1.. US Aro] t '.rpa <br /> of En[in..r. OY.E 6.".bn ]C sr Dv.mb,r 19P] epr ba.". TLVn <br /> u.tev.rrt -M b, .a in f p1:e1 rypr <br /> 3.6 <br />