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PETITION FOR A MODIFICATION <br /> Date <br /> Zoning District <br /> Print <br /> Property Address 111 --�° ,62 2(, PbA <br /> Petitioner Phone J i 1) c � <br /> Owner's Name Phone 1 o <br /> Emailf .: �® <br /> ZBA Original Docket Number <br /> Project is a: [--]Deck ❑Addition ❑House 40ther <br /> Proposed Modification l' wL4'3 , <br /> Current Lot Coverage 3 % Proposed Lot Coverage ) % <br /> Owner's Signature or letter <br /> Petitioner's Signature Pee � ) / <br /> Mail certified copy of Decision to: ��f t'��'k7 6 r IG�5i In e a6 cll <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> TOWN CLERK <br /> DATE STAMP <br /> Scheduled Date <br /> Rev6128118 MASHPEE TOWN CLERK <br /> AUG 10 2021 <br /> HE<C,EIVE-D BY: <br />