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Town of Sunderland
Planning Board
Request forSpecial Permit
Application Number________________
Petitioner (s) _____________________________________________________ Mapญญญญญญญญญญญญญญญ____________Plot_____________
To the Town Clerk,
Pursuant to the provisions of Chapter 40A of the General Laws and the Zoning by-laws of the Town of Sunderland, application is hereby made to the Planning Board for permission to:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
This application is an application for a special permit under Article(s) #____________________and #_________of the by-laws.
(If the petitioner is unsure what category his or her application falls under, please call the Building Inspector, 413.665.1433)
DESCRIPTION OF PRESMISES: Location_________________________________________________(St.)
PRESENT OWNER OF LAND______________________________________________________________
(Name) (Address)
The deed is recorded at the Franklin County Registry of Deeds in
Book____________,Page_________________, or at the Franklin county Registry District of Land Court,
Certificate #__________________________, Book______________,Page__________________.
Signature of Petitioner(s)
(Name) (Address) (Phone Number)
(Signature of Clerk) (Date) (Time)
Received by the Planning Board
Date_____________Time______________
Note to Applicant: Please submit seven (7) copies of this request, list of parties in interest, and drawing of intended plan
(8 1/2 x 11), along with $75.00 to the Town Clerk.
APPLICATION MUST BE FILLED OUT COMPLETELY