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THE COMMONW ' LTH 03F MASSACHUSETTS 1 �� <br /> TOWN OF MOM <br /> ..lv(411�1.. of <br /> .... . JUN 201988,01888 °� I <br /> FORM A <br /> TOM tc <br /> APPLICATION FOR ENDORSEMENT <br /> OF PLAN BELIEVED NOT TO REQUIRE APPROVA �t <br /> B - <br /> File one completed form with the Planning Board and one copy with the 1' <br /> City (or Town) Cb:rk fu accordance with the requirements of Section II-B. <br /> 1'o......................... .... j.�± .....1.5.........19 <br /> Tothe Planning Board: <br /> The undersi-nril. belivvinc that the accompanying plan of hf+ property in the <br /> ....... ........................................docs not conatitutc u subdivision within the tueanine of the <br /> ;. tier nr Tane . <br /> Sobdisision Control .Law, herewith auLmits eaid plan for a determination and endorsement that Planning <br /> Board approval under the Sultilivi+ion Control Law k not required. <br /> I. Name of applicant 1 C1 S... ...!.d !v.?-... .1... ................................ f i. �... ... . ........ <br /> Address ....t.. ...._110.? ...........<<.3.�: .... . '. ......... .. ...... ......... .�`� .... .... I' <br /> t' <br /> •� Name of Engineer or Survevor .. - CAL ... . ........ <br /> Aoblres .... .�LL ...... 176.. ....... <br /> Decd of property recorded in ..... ... S C�. . ......C.)C.w.1 . ( ........ f:egiitr�. <br /> Book.......................... ... ..... ..... .. Pap. ..... .... .... .. . <br /> '. <br /> Location and Description of Property: <br /> 5-i•:n:titre of ��-tier .......... .... . .......... ....... ..... ./. <br /> m n <br />