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Tolman of'Nall epee <br /> 16 Greni A'eck load Aforlh <br /> ���''a,��o• AIashpec,N7assach us(tls 02649 <br /> PETITION FOR A MODIFICATION <br /> Date <br /> Zoning District <br /> Print .71% <br /> Property Address <br /> Petitioner Phone <br /> Owner's Name '� Phone <br /> Email <br /> ZBA Original Docket Number ... <br /> Project is a: ❑Deck ❑Addition ouse ❑Other <br /> Proposed Modification <br /> Current Lot Coverage a % Proposed Lot Coverage <br /> Owner's Signature or letter <br /> Petitioner's Signature <br /> Mail certified copy of Decision to: <br /> _ . _ . _ . _ . . . _ . _ . _ . _ . . . . . _ . _ . _ . _ . _ . .. . _ . _ . _ . _ . . <br /> TOWN CLERK <br /> Scheduled Date DATV:P <br /> AUG 17 2021 <br /> Rev 6128118 RECEIVED BY:�� � � <br />