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Applicant’s Name:____________________________________________________________________

Street Address:_______________________________________________________________________

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

  ______________________________________________________________________

whose mailing and residential address is:_________________________________________________

  ______________________________________________________________________

location of said property:________________________________________________________________

Applicant is (owner, other):______________________________________________________________

Deed duly recorded in the ________________County Registry of Deeds:book_____Page:__________

Nature of application (use additional sheets if need be))

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Applicable section of Zoning Bylaw or General Law (state which, or if both, so state):

_____________________________________________________________________________________

I hereby request a hearing a hearing before the Board of Appeals with reference to the above application.  In the event that a variance required by law to be recorded is granted, I will record the same with the ____________________County  Registry of Deeds, or land court.
 

______________________________
Signature of Applicant

______________________________
Date

Fee $100.00
check made payable to Town of West Stockbridge
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