Wetland Site Inspection outH
SITE INS EC ION_ RI Q E3T NW
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Proposeduse of Land
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Telephone Number
Drawing: Shaw nearest roads, bodies of water, oceans, swamps, wells, or other natural features
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APP ICANT' S SI NATURE
DO NOT WRITE BELOW THIS LINE
Activity is within- areas subject to protection under the Act. An Abbreviated
Notice of Intent (Form 4) should be filed.
Activity is within areas subject to protection under the Act. A Notice of intent
(Form 3) should be filed.
Activity is within the Buffer Zone. A Request to Determine Applicability of the
Act (Form 1) should be filed.
` Activity is outside of the Buffer Zone and areas subject to protection under the
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Act. No forms need to be filed.
Other:
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DARTMOUTH NSE ON OFFICER
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