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Name:________________________________________________________________________________

Street Address:______________________________________________________________________________

Mailing Address:_____________________________________________________________________________

The record title of said property stands in the name of:______________________________________

Whose address is:___________________________________________________________________________________

Location of Property:______________________________________________________________________________
 

Applicant is (owner/other):___________________________________________________________
 

Deed is duly recorded in the ___________________County Register of Deeds: Book_____ Page_____

Zoning District where property is located:_________________________________________________

Nature of Application  (use additional pages for more space)

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Applicable section of Zoning Bylaws or General Laws (state which, or if both, so state):

_____________________________________________________________________________________

I hereby request a hearing before the Planning Board/the Special PermitGranting authority of West Stockbridge, Massachusetts, with references to the above application.  In the event that a special permit required by law to be recorded is granted, I will record the same with the ______________
County Register of Deeds, or land court.
 
 

____________________________
Applicant’s Signature

Date:__________________

Fee: $175.00   amended as of July 2, 2002

Please make checks payable to the Town of West Stockbridge
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