Name of Applicant:__________________________________      Phone:_________________

Mailing Address:______________________________________________________________

Address of Property Under Appeal:_______________________________________________

Property Owner (If not applicant):__________________      Tax Map:___________________


The undersigned requests that the Board of Appeals consider An Administrative Appeal:

Relief from the decision, or lack of decision, of the Code Enforcement Officer in regard to an application for a permit. The undersigned believes that (check one)

______An error was made in the denial of the permit.

______The denial of the permit was based on a misinterpretation of the ordinance.

______There has been a failure to approve or deny the permit within a reasonable period of time.

Other: _______________________________________________________________

Please explain in full detail the facts surrounding this appeal below or, if necessary, on a separate piece of paper.








I certify that the information contained in this application and its supplement is true and correct.
Date_____________________    Signed _______________________________________


This application and all pertinent information must be filed with the Town Clerk plus the appropriate fee to cover the cost of notices and the conducting of the hearing. (7 copies)