25A-183 (4) w
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D FORM A
e r� ok n!c �y4 .. ,, NORTHAMPTON, MA
APPLICA� R ENDORSEMENT
OF PLAN BELIEVED NOT TO REQUIRE APPROVAL
file six—completed forms and plans and—one m lar 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 required.
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1. Applicant(print or type): �� Signature: �---�
Address:0,� l A1diW, Aga6ftTa-41, +f,4 Phone: - 2�
2. Owner(print or type):,1s�&(. Zvc- Signature: 9�"
`D CA--•
Address:d K I64+ Sf e!L6 z �Mk Phone:57y
ALMEr2— HJMCI`{ J 2
3. Surveyor(print or type): I PC—- Signature
Address Phone
Deed or property recorded in Hampshire County Registry of Deeds or Land Court:
Book `G Z- Page.
5. Location and Description of Property:
6 „ 1Wcpr
Date Submitted for Planning Date Planning and
Board Approval: Decision .l , look`Z j
• • r
City Clerk(signature): City Cie
(1/1/98)
SUBDIVISION REGULATIONS-------PAGE 60