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< \ <br /> THE COWCN,JEALTH OF MASSACHUSETTS <br /> of -` ----------------- <br /> OCT 2 4 �°� �Ay <br /> FORM A <br /> APPLICATION FOR ENDORSEMENT <br /> OF PLAN BELIEVED NOT TO REQUIRE APPROVAL' <br /> File one completed form with the Planning Board and one copy with the <br /> City for Town) Clerk in accordance with the requirements of Section II-B. <br /> No. . . . . . . . . . . . . . . . . . . . . . . . . 57. . . . . . . . . . . . .19?a. <br /> To the Planning Board: <br /> The undersigned, believing that the accompanying plan of his property in <br /> the .. .4f- -e' .SF-t0eF-Tdoes not constitute a subdivision within the <br /> City or 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. . . . . . . . . . . . . . . . . . . . . . . . <br /> Address. . . .PO. .BeY .g:?,t . . ✓�,_, {L� J 1;�:"�"�.5:. . . . . . . . . . . . . <br /> . . . . . . <br /> 2. Name of Engineer or Surveyor. . . �cJ. . . . " <br /> Address. . Pd, S�'0� . . •. 1:":' �. M °'� . . . 0�53.7. . . . . . . . . . . <br /> 3. Deed of property recorded in . . �V, Z . . . . . . . . . . . . . . . . . . .Registry. N <br /> Book . . . . . . .'.i.:�. . . . . . . . . . . . . .Page. . . .���. . . . . . . . . . . . . . . . . i <br /> 4. Location and Description of Property: ' <br /> Signature of owner , <br /> Address. . y.F.. . .0hf.#q, . . . C <br />