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00 <br /> Town ee <br /> 16 G4,ecat A�?ck.(Pad Nbril? <br /> PETITION FOR A MINOR MODIFICATION <br /> Date <br /> Zoning District 5 <br /> Print <br /> Property Address <br /> Map: 1o,5 Parcel: 1 U3 <br /> Pa <br /> + i <br /> Petitioner NGt.l�l ' <br /> _f + �v wit h tC2 --3-n-1, .Q r 4- Phone q 7 91 �s a - ��a <br /> ri f <br /> Email T e- 2;,( QI Y`n f 1V e 0()Vkl 0 <br /> Owner's Name � � khM t Tom,.,.,.,.-.,.�_ '� <br /> � � - Phone 0( <br /> ZBA Original Docket NumberV- 00/o -0z,. <br /> Project is a: .Deck ❑Addition []House ❑Other <br /> Proposed Modification r< P/-OctS( <br /> frje&06 <br /> Ala ourj <br /> Owner's Signature or Ato: <br /> Petitioner's Signature ----- <br /> Mail certified copy of ✓ �f l dl(Q �, <br /> . AI . i AAS AI AAAA[ AI . AI AAAA • AAAA AI AWYYI Y Ali ■ . ■ . ■ . ■ HAIR i IAAAAI ■ . AI All^ A IIA^ � AAAAIA • IIIIAAf • Inllll R AAAIAA • <br /> TOWN CLERK <br /> Scheduled Date DATE STAMP <br /> MASHIDEE TOWN CL <br /> Rev 6105115 FEB <br /> 20 <br /> RECEIVED 183Y <br />