TOWN OF
PROJECT APPLICATION SUMMARY FORM
Project Title: ___________________________________________
APPLICANT INFORMATION
Submitter: _________________________ Title or Position:________________
Group or Committee Affiliation (if any):_____________________________________________
Submitter's address, contact phone number, and email:__________________________________
______________________________________________________________________________
______________________________________________________________________________
PROJECT INFORMATION
Purpose (please check all that apply)
Project Site Address:___________________ _______ Open Space
____________________________________ _______ Recreation
Project Site Assessors Map/Parcel:________ _______ Historic
Project Site Deed Book/Page:____________ _______ Housing
Current Owner:_______________________
Brief Project Description:_________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
COSTS
|
Fiscal
Year |
Total
Project Cost |
CPC
Funds Requested |
Other
Funding Sources (amount and source) |
|
2007
|
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|
2008
|
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|
2009
|
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|
2010
|
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|
2011
|
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|
Total
|
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Signature
of Applicant:______________________________Date:________________________
For
Community Preservation Committee Use:
Form Received
on:_______________________ Project Presented to CPC on: ___________________
Reviewed by:___________________________ Determination:_______________________________