36-071 (3) ni MI AY C UO2 FORM A
I
(( NORi T ti1PTON, T A
APPLICA OR ENDORSENGNT
OF PLAN BELIEVED NOT TO REQb-RE 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.
I(we)believe that the attached plan of property in the City o£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.
The Wzorek Family Investment Trust 1 ,
William P. Wzorek, Sr. and James F. Wzorek Jr. ,r ust s f `!
1. Applicant(print or type): Signature: r- g lr
AIV
Address: 383 Westhampton Road, Northampton Phone:r53 The Wzorek Family Investment Trust an2. Owner(print or type): Melanie Gulow SipatureAddress: 363 Westhampton Road. Northam tp on Phone
a
3. Surveyor(print or type):�WJT Li=Y ipature: �Lolvl.
Address: /&Lo)e-7"FAry1 TOr-? _M,Q Phone: �e _ ,L
4. Deed or property recorded in Hampshire County Registry of Deeds or Land Court:
Book -' Page
5. Street Name, and Property Locaiion and Description:
Street Name: W,U S7 NA 1Nl i7 10U &2A L-) F 1 T R-OA D
Description:
A o Z.aa G Ac f PAP-cE 49.?t At
a+- 3, 3 0 :C-1 AS G 4&w&-L
LA Q I" ',i
6.
M11M 01
n;
7. Number of newly created lots:
Date Suhrut ed for Planning Date PlannL'- 4
Board Approval: Decision File-
-0
City Clerk(signature): City Clerk s
(511012001)
SUBDIVISION REGULATIONS