35-005 (2) �; 1?
r �
FEB 6 '10 FORM A
NORTHAMPTON, MA
ICATION FOR ENDORSEMENT
OF PLAN BELIEVED NOT TO REQUIRE APPROVAL
File five completed forms and plans and one mylar with the City Clerk and the
Planning Board in accordance with the requirements of Section 3.02.
To the Planning Board:
The undersigned, believing that the accompanying plan of his/her 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 lk2Lea.'^t
Prini or type name Signature
64a J,
Address n T Phone
2. Owner �1,.�,.�
Print or type name Signatu
Address , Phone
7 � _
3. Surveyor L;-, 1 r
Print or type name Signature
l
Address Phone
4. Deed or property recorded in t'd =gs`ln Vii Registry,
Book ,1 Page I `b
S. Location and Description of Property:
6. Assessor's Map ID: Lot(s) :
Date Submitted for Planning Date Plannin a d
Board Approval: Decision Ile
City Clerk: City Cl rk:
(Signature) (Signature)
(8/13/91)
SUBDIVISION REGULATIONS-------PAGE 60