Conservation Restriction Reserved Right Form

Conservation Restriction Reserved Right Form

Conservation Restriction Program 464 Abbott Ave, Leominster, MA 01453
This form is for landowners seeking to exercise reserved rights permitted in their conservation restriction (CR).

Depending on the terms specific to your CR, some activities may require approval from the CR holder (The Trustees), while others may only require written notice.

For the CR Program to determine whether your request is consistent with the CR’s Purposes and Conservation Values, please complete this form with as much detail as possible. We understand that projects may evolve and ask that you keep us updated as needed.

A copy of your Conservation Restriction is available here. An activity may be prohibited under Prohibited Uses but exceptions may exist in Reserved Rights. Refer to both sections for clarity.

For questions or assistance completing this form, please contact us at crprogram@thetrustees.org or 978-840-4446 (ext.3). Our CR Landowner Handbook is also a useful resource.
Contact Information:
Current Landowner(s)

First NameLast Name
First NameLast Name
E-mail
example@example.com
CR Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1) Does your request require Trustees notice or approval? Refer to the Reserved Rights section of your CR.

Notice requiredApproval requiredI'm not sure
2) What is the nature of your request?

ConstructionUtilitiesLand ManagementRecreationOther
Construction Type

New StructureStructure RemovalStructure ReplacementAdditions or RenovationsStructure ImprovementParking Area Development
Utilities Type

Solar InstallationSeptic System Removal/Replacement/TestingElectrical/Power Installation
Land Management Type

ForestryAgricultureErosion ControlInvasive Plant RemovalBeaver Control
Recreation Type

Trail ConstructionKiosk InstallationBoardwalk/bog bridging Installation
If none of the above, please specify the nature of your request.
3) What is the action you're requesting approval for?
4) What is your proposed timeline? Please include start and end dates, if possible.
5) Describe the scope of the proposed activity. Include the size or dimensions of any structures, their intended use, necessary equipment or materials, and any actions taking place.
6) Please attach supporting documents such as sketches, maps, blueprints, written plans, or photos.

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7) What is the location of the proposed activity? Please specify if it is within a building envelope or special use area.
8) List all permits, licenses, or approvals needed, such as building permit or approval from your town's Conservation Commission.
9) Any comments, questions, or concerns?
Should be Empty: