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Personal Wireless Services Communication Facilities Special Permit
Please provide twelve (12) copies of the application along with ten (10) 11” x 17” sized plans and two (2)
24”x 36” sized plans for the Planning Board. Please also provide an electronic copy of the application
and plans in pdf format.
Date ______________________ Application # _________________________________
Name of Applicant Name of Owner/Representative _____
Mailing Address Mailing Address ___________
Phone Number Phone Number ___________
Email Address _____________________________ Email Address ________________________________
Location of Property _____
Assessors Map Lot Zoning District ______________
Current Use of Property
The applicant is the (circle) owner or agreed vendee ______________________________of the
Communication Facility situated in Brewster on the above property, more particularly described in the deed
recorded in Book Pg(s) (copy attached).
Wireless Telecommunication Facilities (Antennas on existing towers and side or roof mounted)
____
_________________________________________________________________________________
New Ground mounted Wireless Telecommunication Facilities _____
Brewster Planning Board
2198 Main Street
Brewster, MA 02631-1898
(508) 896-3701 x1133
brewplan@brewster-ma.gov
Date & Time Received
Town Clerk’s Office
Revised 05-2018 PWSCF Application Page 2 of 2
Provide a narrative description of the proposal that must address the findings and all standards of
Section 179-40.1 Personal Wireless Services and Communication Facilities Bylaw Wireless
Telecommunication Facilities, and for full specifications on site plan submission requirements.
The applicant proposes to (describe) ___________________________________________________________
___________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
as shown on the accompanying plans titled ___________
________________________
Signature of Applicant ____________________________________
Signature of Owner or Authorized Representative
(If not Owner, please attach Agent Affidavit)
All PWSCFs shall comply with the Performance Standards set forth in Brewster Zoning Bylaw Section
179-40.1 in its entirety and the Rules and Regulation of the Brewster Planning Board.