23D-179 (2) • FORM A
NORTHA .?TON , MASS.
ate
APPLICATION FOR ENDORSEMENT
OF FLAN BELIEVED NOT TO REQUIRE APPROVAL
1
Pile one completed form with the Planning Board
and one copy with the City Clerk in accordance with
with reouireme.nts of Section 3 . 02 .
To the Planning Board :
The undersigned , believing that the accompanying plan of
his 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 LaN
is not required .
1 . Applicant Doh/ E. M TU.S %It r ��--e4--
Print or type nare S nature
37 AlaTT/N 6 AVE 41o/0-/n em,v
Address �
2 . Owner Do iv E. AAA-T✓S ,4a^ C
Print or type name Signature
37 I(/ UTTI N 6 AVEW OPTIMAPTO ti
. Address
3 . Surveyor P4�4up 4 FoRr3S
Print or type name Signature
77/ LEwYY St- W. SPRIVP/F'-b
Address
4 . Deed or property recorded in PogTfiAri ToN Registry ,
Book 020170 Page _ 73 .
5 . Location and Description of Property :
r . g OWE --7°
JUN 3 1983
-7..., Date of Submission 04.1
DEPT.OF BUILDING INSPECTIONS
NORTHAMPTON,MA.01060 } •
City Clerk • ,,lJP (7,_,
V Sig a ure
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