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Application for a Noise By-law Exemption

Name of Applicant:

Phone Number:

Email:

Applicant's Mailing Address:

Is the address of the location for the requested noise exemption the same as the applicant's address?

Yes

Please give a description of the source of noise for which the exemption is sought:

Please give a statement of the particular provision(s) of the Town's Noise By-law from which exemption is sought:

Date(s) and time period(s) of the noise by-law exemption:

Please explain the reason why the noise by-law exemption should be granted:

Please enter the steps, if any, that are planned or presently being taken to bring about compliance with the Town's Noise By-law:

Declaration of the Applicant

I declare that the information contained in this application is correct.

By typing in your name below, you are agreeing to the above Declaration.

Signature of Applicant:

Date:

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