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f <br /> 6, ( ,,. <br /> *� <br /> PETITION FOR A MINOR MODIFICATION <br /> Date <br /> �-� a � � <br /> 3 <br /> Zoning District h <br /> Print <br /> Property Address <br /> Map: a Parcel: 1 => <br /> Petitioner , 6 2-y A-)4 - AC 39a)-k- Phone <br /> Emaily , torLet—fid c e1DA-- f/ m r-s� <br /> Owner's Name 3-e o c� r�- Sc�n -# J l►1 U Phone 47, <br /> ZBA Original Docket Number F n W f 1 6)l eo 3 <br /> ❑Addition Lt�'i-iouse ❑Other <br /> Project is a: []Deck <br /> Proposed Modification Sl T 6" ,y 4 4/cuS c ®tI^J 6ffiOc lgn 6o e-S-AJU'T <br /> U� 13o,v l v s7*Li cn (7A) �2 oT141 rvi44 vj-7v) <br /> tC cS SSIf1,,/ C V q CT kA)wv/N <br /> Owner's Signature or letter <br /> Petitioner's Signature <br /> Mail certified copy of Decision to: 6 ;41t a 2 E_ <br /> •■. • r r i ■ w•iw • � • rr a � • ■ri ■ n•r • ■■w r ^ • s r rr ■ � • � ■ �■■ • � • ■� • ■rr r r•r ■ ■w• • <br /> TOWN CLERK <br /> Scheduled Date f'���`CGf C� � DATE STAMP <br /> MASHPEE TOWN CLERK <br /> FEB 2 4. 2017 <br /> Rev 6/05/15 RECEIVED BY---`: � <br />