11A-020B upland road planningFORM A
NORT TON, NIA
APPLICATION FOR ENDORSEMENT
OF PLAN BELIEVED NOT TO REQUIRE APPROVAL
File seven completed and signed forms and plans and one mylar 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.
1. Applicant (print or type):. = Signature:
app 1�� Phone: - o
Address: ���,�.5 �--�� �►
TAT
2. Owner (print or type): / ^j G _Signature:
Address: - Phone:_ g,- < /-,v
3. Surveyor (print or type):
Address• ' ' i.S Phone: '"/
4. Deed or property recorded in Hampshire County Registry of Deeds or Land Court:
Book,6 Page _
5. Street Name, and Properly Location and Description:
Street Name: U��A�i_a �D _ 4E
Description:
C vT D 07 90 /& 4 UY �l OIY! 1";1'70 f �WP
6. Assessor's Map ID: //.4 Lot(s): ,,?�
7. Number of newly created lots:
Date Submitted for Planning
Board Approval:
City Clerk (signature):
(July 2000)
Date Planning B r
Decision File . 1 , - . J /om
City Clerk
SUBDIVISION REGULATIONS- - - - - --
Scanned 11 A r OZ-0
Digitized
Checked _—