Q r --
`��
FA
TOWN DF AGAWAM
36 MAIN STREET AGAWAM, MASSACHUSETTS 01001
ZCo h� Tel. 413-786-0440
F O R M A
APPLICATION FOR ENDORSEMENT
OF PLAN BELIEVED NOT TO REQUIRE APPROVAL
FILE ONE COMPLETED FORM WITH THE PLANNING BOARD AND ONE
COPY WITH THE TOWN CLERK IN ACCORDANCE WITH THE REQUIREMENTS OF
SECTION 11-B
Agawam, MA&j()- A. .° Q. 5. . .
TO THE PLANNING BOARD:
The undersigned , believing that the accompanying plan of his
property in the Town of Agawam does not constitute a subdivision
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. NAME OF APPLICANT_ , ? 5�.�!�. : . [C: . . . . . . . . . . . . . . . . .
Address jo OtL'lc 14cd�w o �3 o
2. NAME OF SURVEYOR , �� S • S ►n�► i T}-(
Address S H AkL-"V- Mo EAST Lbr4 RA CA0at J
3. DEED OF PROPERTY RECORDED IN H A MP t>tF n, Co�.-3 Ej T CZC&I Shy
Book Page 2-Z9 -
4. LOCATION OF PROPERTY: J d-7 M I D G E W A-7 prt 4 GA i,/A
5. DESCRIBE THE PROPOSAL IN THIS SUBMISSION.
E�Cff [r LoT NTD 3 Lo-rS
C .WEE
C)
AUG
�OAR�
A��C EMENTS TWO ORIGINALS AND TWO COPIES OF PLAN BY CERTIFIED
LAND SURVEYOR.
Signature of OwA�I //
Address �[� !. tc � � -