WPA Form 5 "Order of Conditions - Signatures Page" - Massachusetts

What Is WPA Form 5?

This is a legal form that was released by the Massachusetts Department of Environmental Protection - a government authority operating within Massachusetts. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 18, 2020;
  • The latest edition provided by the Massachusetts Department of Environmental Protection;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of WPA Form 5 by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Environmental Protection.

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Download WPA Form 5 "Order of Conditions - Signatures Page" - Massachusetts

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Provided by MassDEP:
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
MassDEP File #
WPA Form 5 – Order of Conditions
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
eDEP Transaction #
City/Town
E. Signatures
This Order is valid for three years, unless otherwise specified as a special
condition pursuant to General Conditions #4, from the date of issuance.
1. Date of Issuance
Please indicate the number of members who will sign this form.
This Order must be signed by a majority of the Conservation Commission.
2. Number of Signers
The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant. A
copy also must be mailed or hand delivered at the same time to the appropriate Department of
Environmental Protection Regional Office, if not filing electronically, and the property owner, if different
from applicant.
Signature
Printed Name
Signature
Printed Name
Signature
Printed Name
Signature
Printed Name
Signature
Printed Name
Signature
Printed Name
Signature
Printed Name
Signature
Printed Name
by hand delivery on
by certified mail, return receipt
requested, on
Date
Date
wpaform5.doc • rev 5/18/2020
Page 1 of 1
4
Provided by MassDEP:
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
MassDEP File #
WPA Form 5 – Order of Conditions
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
eDEP Transaction #
City/Town
E. Signatures
This Order is valid for three years, unless otherwise specified as a special
condition pursuant to General Conditions #4, from the date of issuance.
1. Date of Issuance
Please indicate the number of members who will sign this form.
This Order must be signed by a majority of the Conservation Commission.
2. Number of Signers
The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant. A
copy also must be mailed or hand delivered at the same time to the appropriate Department of
Environmental Protection Regional Office, if not filing electronically, and the property owner, if different
from applicant.
Signature
Printed Name
Signature
Printed Name
Signature
Printed Name
Signature
Printed Name
Signature
Printed Name
Signature
Printed Name
Signature
Printed Name
Signature
Printed Name
by hand delivery on
by certified mail, return receipt
requested, on
Date
Date
wpaform5.doc • rev 5/18/2020
Page 1 of 1