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z (?/'..A a <br />J <br />16 ("rurl't mul ,Awth <br />Idu <br />PETITION FOR A MODIFICATION <br />Date <br />Print <br />Property Address <br />Petitioner ("-i I <br />Zoning District <br />Phone,,,.,.,,�)Z,) �3L <br />Owner's Name Phone" <br />('sy') <br />ZBA Original Docket Number <br />Project is a: L'N'Deck IJ Addition El House `9 Other zlr�c, <br />Proposed Modification <br />ct 51y,Q) 2 <br />Current Lot Coverage <br />Owner's Signature or <br />Petitioner's Signature <br />Mail certified copy of Decision to: <br />Scheduled Date <br />Rev 6128118 <br />TOWN CLERK <br />DATE STAMP <br />