TOWN OF GREENE PERMIT FOR FILL                     14-  ________

 

 

 

APPLICANT ___________________________________________________________

 

ADDRESS ______________________________________________________________

________________________________________________________________________

________________________________________________________________________

 

 

MAP ___________                                         LOT _____________

 

LOCATION ____________________________________________________________

 

ZONE _________________________________________________________________

 

SOURCE OF FILL ______________________________________________________

 

TYPE OF FILL _________________________________________________________

 

CONTRACTOR _________________________________________________________

 

SPECIAL CONDITIONS _________________________________________________

________________________________________________________________________

 


DEP APPROVAL                              YES                                         NO

 

 

 

EXPIRATION DATE _______________________________  FEE $10.00

 

 

PERMIT MUST BE SIGNED BY ONE OF THE FOLLOWING:

 

 

___________________                      __________________________________________

DATE                                                     TOWN MANAGER

 

___________________                      __________________________________________

DATE                                                     KEN PRATT, CODE ENFORCEMENT OFFICER