Pine Valley Rd1'.
Addl-ess
• Surveyor •
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Print cr type name
12 ' [2 L i;? f 'T .7' . '- �-�- yc,F i'
APPLICATION FOR ENDORSEMENT
OF FLAN BELIEVED NOT TO REQUIRE APPROVAL
Pile one completed form with the Planning Board
and one copy with the City Clerk in accordance with
with requirements of Section 3.02.
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 sut its said plan' for a determination and endorsement
iann r =card approval under the Subdivision Control Law
is not required.
a CITY �� krti tmJ 6)1910 `' �- / d� ` 0
1. Applicant
Si gg n a ture
Print or type name
f . 24` Lo cu 1 r ) `mow
Address
2. Owner �fl''`R--1 min
• Print or type name ' Signature
Address
4, -Deed or property recorded in Registry,
Book Page
5. Location and Description of Property: L
tqi- ..14 17 l
tiC.,�
Date of Subm
Ass't.C1 -y Clerk
FOR;; A
NORTHAMPTON, MASS.
Date
Signature
•
•
lJe°i l )-C Q
n November . 1984
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