14-006 390 Kennedy Rd planningFORM A! s
APPLICATION FOR ENDORSEMENT
F PLAN BE VED NOT TO RE U
Q IRE APPROVAL,
File one corripleted form with
and one copy with the rr the Planning Board
cordauce with Cit (or Town) Clerk in ac
the requirements. of Section 11 -8.
(CUY or Town), Mass., K/ OL/. 22 19
To the Planning Board,
The undersigned, believing that the
the City ccompanying Plan of his Property in
y �° ° � ° a) of DV2TN NOM / does
the meani not constitute a subdivision ag of the Subdivision Control within
Law. herewith submits said plan for a
determ�,tioa and endorsement that planning Board approval under the Sub-
division Control Law is not required.
1 • Name of Applicant
� `l) r ,
Address ,L �} faoaevC�" vr`
N&p - r!9 M CrLju tnA .
Z. Name of Engineer or Surve or
y jA - � , a£s ;
Address r77
3 . Deed of r
P perty -recorded in
Book Registry,
— .
Page L
4• Location and Description of Property:
-k c r r
cq ,
Signature of owner
Address 1 "
", I- L R
/ umg -'Cl d,,_
Filed
d�r/-