10B-111 37 front planning*Ag'
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FORM A
NORTHAMPTON, MASS.
Date
APPLI(:`AttW1 FOR ENDORSEMENT
OF PLAN BELIEVED NOT TO REQUIRE APPROVAL
File one completed form with the Planning Board
and one copy with the City Clerk in accordance with
with requirements of Section 3.02.
To the Planning Board:
The undersigned, believing that the accompanying plan of
his property in the City of Northampton does not constitute
division within the meaning of the Subdivision Control Law,
herewith submits said plan for a determination and endorsement
that Planning Board approval under the Subdivision Control Law
is not required.
1. Applicant e�i.A o.s A . ���- � G "
Prin or type name / Xi
a �l SSA, �+ 4-5 � v /h 0
Address Cv },
2. Owner o�a�ctis A, ka1, /�
Pri or ty a name Signature
Address
3. Surveyor Almer Huntley, Jr. & Assoc. Inc.
P rint or type name 7
125 Pleasant Street Northampton, MA 01061
Address
4. Deed or property recorded in Hampshire County Registry,
Book o2 ,6 _ Page /G.S
5. Location and Description of Property:
Tuio � L S nn/ S-'odTh� i O F �2onTT' S7�r�7 LEAD S
"o y>
APPROVAL '
ra 0 r
t RLQU>r.Ep
4 .
Date of S
City Cler
33
1 1 -f PT Date of Submission pri1 1Q,
City Clerk