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r <br /> Development of Regional Impact (DRI) <br /> Referral Form , <br /> f , <br /> Please attach a copy of the original municipal development permit application or site plan .k,. <br /> review. subdivision, or other application showing the date on which it w r P f g as received by the <br /> Municipal Agency. Receipt o this information via the U.S. Mail or delivered in person to the <br /> Cape Cod Co ion constitutes a referral for purposes of chapter 716 of the Acts of 1989 ' <br /> amended. <br /> Referred by: <br /> Town and AgencyFIJI <br /> 1 <br /> e ■I <br /> Official �2La- <br /> u,,-- Mandatory referral <br /> Discretionary referral <br /> Limited Discretionary referral (please see the back of this fori '1* <br /> Project Name- <br /> Project �S'c.c �� 7 4.0 <br /> i <br /> Project Proponent Name I <br /> Address <br /> 44+rz <br /> Telephone <br /> I <br /> .icy. <br /> Brief description of the project including, where applicable, floor area, ' <br /> lots, units, acres and specific uses: +�. <br /> �A f7Q 6CZI 1 (5,9 3 9 rt-,r r Ps min <br /> 4 I <br /> i k %4 <br /> I <br /> Project location; lot <br /> !1 <br /> IL <br /> ,P <br /> �{ r <br /> List municipal agencyf ies) before which a municipal development permit is <br /> pending: <br /> MO <br /> ,5h 62 /0 r-2 t2 10 S: r <br /> I <br /> r <br /> f• <br /> -,L4. <br /> 1 <br /> Print Name of Authorized natur Da e <br /> Referring Representative <br /> resentative •' <br /> t <br /> Pe rwar d to: I;+f <br /> Cape Cod Commission �� <br /> 3225 Main fi <br /> Street <br /> Barnstable, Massachusetts 02630 <br /> ,t; <br /> �3 , <br /> I <br />