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Town of Nas1��e� <br /> 16 Q ccii Heck 1{oad JAf6iih <br /> Washpee;_73 assachuseh,�0,?649 <br /> PETITION FOR SPECIAL PERMIT <br /> Per MGL Chapter 40A §9 and Town of Mashpee Zoning By Laws of 1987 <br /> Date Zoning District <br /> Print <br /> Property Address l i" C s` Kb 'V i� rt 1+ <br /> Map Parcel <br /> Petitioner TV AI N w ! Phone G' �`l 14 z,0 <br /> Email <br /> a <br /> Is this property within the Precontact or the Postcontact Archaeological Sensitivity areas YES ❑NO <br /> Applying for (Check appropriate hox(s)): <br /> ❑ Accessory Apartment ❑Commercial ❑Sign ❑Bed and Breakfast []Private NonProfit <br /> ❑Hospital/Nursing Home []Outdoor Recreation ❑ Indoor Recreation SJDocks <br /> ❑Lumberyards/Landscaping [] Automotive Repair ❑Drive In []Wireless Services <br /> []Medical Uses ❑Kennel ❑Retail Sales ❑Eating Establishment []Other <br /> BRIEF DESCRIPTION <br /> Owner's Signature or lett <br /> RODNEY C. OLLINS <br /> Petitioner's Signature Town Manager <br /> Mail certified copy of Decision to: AAA`"ge ow <br /> TOWN CLERK <br /> Scheduled Date '� `� E TOWN OLERRATE STAMP <br /> Rev. 3106115 MAY 3 201 <br /> RECEIVED By <br />