C.M.R. 06, 096, ch. 402, app 096-402-A
(date)
(name of applicant)
(address of applicant)
Dear (name of applicant):
I, being a landowner who has (sole or joint) title, right or interest to property located within 250 feet of the proposed solid waste handling area for the (name of facility), hereby give my permission to reduce the 250 foot setback restriction for the location of the (name of facility) Transfer Station (or Storage Site). I also acknowledge that I have been provided with a copy of the plan for the proposed solid waste facility, showing the proposed location of the waste handling area in relation to my property.
_________________________________ ________________________
Signature of property owner Date
_________________________________ _________________________
Signature of witness Date
C.M.R. 06, 096, ch. 402, app 096-402-A