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Town ofMasI'i-pee <br /> • Zas)t�ee,1'assachusctts 02649 <br /> PETITION FOR A MODIFICATION <br /> Date C) <br /> Zoning District 1�'C,3 — <br /> Print <br /> Property Address L2'..A �A, J t <br /> Map: 99 Parcel: <br /> Petitioner 1?,c(MloWw b CGL4S Phone 9Y-9 FIZZ <br /> Email <br /> Owner's Name / q � f (�1, Phone <br /> ZBA Original Docket Number /1�2D ,tj 19 ' 100/, <br /> Project is a: XDeck 4Addition []House []Other <br /> Proposed Modification 6&VAIt, <br /> /W" ,vac. A—At - 1"no-7r 1061e, Abotit2 <br /> Owner's Signature or letter <br /> Petitioner's Signature <br /> Gyj�lb <br /> Mail certified copy of Decision to: �Qk,c Z �_ ,vTSW l�v�C�4•� �cG. <br /> p0 /SM ii Y <br /> TOWN CLERK <br /> �4 DATE STAMP <br /> Scheduled Date t <br /> Rev 513112017 <br />