29-0104 •4'M
R@ ROVE
FORM A
LJLN I d ION -- NORTHAMPTON, MA
DEFT Of BJ!i.OIG NSFECTV4S PLICATION FOR ENDORSEMENT
hORTharfnBELIEVED 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 (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 ,,:quifzu.
Applicant (Print or type): Doug Kohl, Tofino AssocSignature:
Address: 31 Campus Plaza Road, Hadley MA 01035phone: 256-0321 I
f 4 C-.
Tofino Assoc. &
2. Owner (print Or type):Edward J & Joan A Mazur
Address: 841 Burts Pit Road, Northampton Phone�-A4-2134 to
3. Surveyor (print or type): Harold L Eaton &Assoc Signatur�: �� T��
235 Russell St, Hadley MA 01035 584-7599
Address Phone
4. Deed or property recorded in Hampshire County Registry of Deeds or Land Court:
4657 217
Book 1485 Page 368
Location and Description of Property:
Lots on the North side of Burts Pit Road.
36 105
6. Assessor's Map:29 ot( . 10
Date Submitted for Planning Date Planning and /,
Board Approval: Decision Filed 7
City Clerk (signature): City Clerk (si re
(1 /1/98)
SUBDIVISION REGULATIONS -------PAGE 60