35-256 (5) FORM A
6 1%9 NORTHAMPTON, MA
PLICATION FOR ENDORSEMENT ��
OF-PtAN BELIEVED NOT TO REQUIRE APPROVAL
File six completed forms and plans and one mylar with the City Clerk and the Planning Board in accordance with the
requirements of Section 3.02.
I (mw believe that the attached plan of property in the City of Northampton does not constitute division within the
meaning of the Subdivision Control Law, and herewith submits said plan for a determination and endorsement that
Planning Board approval under the Subdivision Control Law is not required.
1. Applicant(print or type): Signature: C-
Address: 7�r Tuor-rs y H1 LL P D Phone:---58&-4/57—
,Vog THA 1,41-"cam
2. Owner(print or type): —4�;fi M 6 Signature:
Address: Phone:
3. Surveyor(print or type): h 1�Np1�� �Pttc `$`ignature:
r,bl)TWxga-ro�cl �- iv /
Address Phone
4. Deed or property recorded in Hampshire County Registry of Deeds
I�74 147
Book 7-1295 Page C1�/
5. Location and Description of Property:
U 0-7 h( 5 rJE L)F T vi, C y H/CrL- f�'1� �� y_ U/Z—
6. Assessor's Map ID' Lot(s): Z t—Z
Date Submitted f Tanning �? , Date Planning Bo
Board Approva . r - _ 7 Decision Filed:
City Clerk(signature) City Clerk (signal
ur �,�