36-213 (2) �E C E li V E
�lnv 5 O ')!01 FORM A
NORTHAMPTON, MA
INSPECTIONS
t
A 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.
T.
1. Applicant 06b CCot- f
C Jt'�C tc�n a,,SPrint or type name Signature(
Address !�L Phone
2. Owner
Print or type name Signature
IBS
3oc, ;*-n ; '5a 7-960(
Address 0),Oj -� Phone
3. Surveyor t�lG�"LGLI J-F• L w c5 1
// Pr nt cr type name Signature
tai�t5 ,
—71�)L
Address -' Phone
4. Deed or property recorded in S C2(rte Registry,
Book q-7 L'C Page
S. Location and Description of Property:
04 1120-a k v7 _L>o
6. A 136f Bar' Map 11): `'1 Lot(s) :
Date Submitted for Planning Date Planni o
Boardr'A roval°:" �i..l S'' ax 61 Decision F' e o Cf
City y City Clerk:
ig ature) (Signa r
SIIEDIV1.310 d REG=TyONS-------PAGE 60 �i ofNorthamotonSurve File: 2001-023
I