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Ct <br /> 9 - <br /> THE COMICNJEALTH OF MASSACHUSETTS <br /> 04 <br /> s. <br /> FORM A �- e <br /> APPLICATION FOR ENDORSEMENT <br /> F PLAN BELIEVED NOT TO REQUIRE APPROVAL - <br /> e one completed form with the Planning Board and one copy with the <br /> City (or Town) Clerk in accordance with the requirements of Section II-B. <br /> No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 � <br /> To the Planning Board: <br /> The undersigned, believing that the accompanying plan of his property in <br /> the P., .[or. *Tow . . . . . . . .does not constitute a subdivision within .the <br /> ity Town <br /> meaning of the Subdivision Control Law, herewith submits said plan for a <br /> determination and endorsement that Planning Board approval under the <br /> Subdivision Control Law is not required. <br /> 1. Name of Applicant. . . .i.��C,: :�S. . . .:. . �C3`!\F4 . . . . . . . . . . . . . . . . . . . . f <br /> Address. ...' I. . . . . . . . . . <br /> ... .. . . /. . . . .,[�l.�jt�. . . . :iQ:. . �i <br /> 1: <br /> Ca;i;{� _E <br /> 2. Name of Engineer or Surveyor . �?S . . . . . _'� <br /> A d d r e s <br /> . .,lo . . . . . . . .112 <br /> i <br /> 3. Deed of property recorded in . . . . .. . . 5.�� . . . . . . . . . . . . . . .Registry. <br /> Book. . :7:/.? �. . . . . . . . . . . . . . .Page . . . . . .ee. �. . . . . . . . . . . . . <br /> 4• Location and Description of Property: <br /> d4 W1 e t j To?,J Q PJA� <br /> Signature of owner. . . . . . . . . . . ��. . . . . �'�`—'J <br /> Address. . . . .�::': . . . . . . . . . . . . <br /> ��/S6v tA�- QZL�9 <br />