29-476 (3) a (i
FORM A
NORTHAMPTON, MA
,r ,
APPLICATION FOR ENDORSEMENT •
OF PLAN BELIEVED NOT TO REQUIRE APPROVAL
File seven completed forms and plans and one mylar with the City Clerk and the Planning Board in accordance with
the requirements of Section 3.02.
1(we)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.
I. Applicant(print or type): Susan aria-O'brien Signature:
Address: 677 Burt* Pit Road, Northampton, XA Phone: 587-9413
2. Owner(print or type): Josegh 6 Patricia Brin Signature:
Address:Burts Pit Road, Northampton, MA Phone: 585-5159
Heritage Surveys, inc �-
3. Surveyor(print or type): Signature:
Address: College Highway, Southampton, KA Phone:527-3600
4. Deed or property recorded in Hampshire County Registry of Deeds or Land Court:
Book 2206 285
Pa a
8
S. Street Name,and Property Location and Description:
Street Name: Burt& Pit Road
Description:
Parcel 1 having an area of 30,000 S.F., Parcel 2 having an area of 2.930 Acres and
Parcel 3 having an area of 3.606 Acres as shown on the accompanying plans dated July 15,
2002
6.
7. Number of newly created lots: 3
Date Submitted for Planning Date Planni
Board Approval: Decision F' s
City Clerk(signature): City Clerk(signature):
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SUBDIVISION REGULATIONS-------PAGE 57