07-035 (7) r.1
f - �
FORM A
NORTHAMPTON, MA
6 -to- cites
APPUCATION FOR ENDORSEMENT
OF PLAN BEUEVED NOT TO REQUIRE APPROVAL
File five completed forms and plans and one aylar 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 l-f°T 74 Q W/' i {Dusk,-G'(--
Print or typename Si afire
�
/2.4r-0.44 ce lfes14_4,4 I — 5'6 L/57¢
Address Phone
2. Owner
Print or type name Signature
Address Phone
3. Surveyor
Print or type name Signature
Address Phone
4. Deed or property recorded in Ar/'t Registry,
Book Page
5. Location and Description of Property: LobA4. ' '�. — C'�'tif °1 cct C.C.
94
6. Assessor's Map ID: ALot(s):
Date Submitted for Planning Date Planning'Board
Board Approval: Decision Filed: July 10 1992
d
City Clerk: City Clerk: }'; " , / i
6 .t�
(Signature) (SLgna ur 1
(4/11/91)
SUBDIVISION REGULATIONS PAGE 60
07-03s