117 WEBB STREET - ZONING Form A Decisions
y, Ctv of Salem, 4HwasaChusetts
T Planning �Ivarb
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obalem,,l�Iaesachusetts 01970
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e 4 NOTICE TO BE ATTACHED TO
FORM"A"APPLICATIONS
_LU r See Form "A" applications for
complete instructions for filing.
All insertions shall be typewritten
or printed neatly in ink.
Date:
City Clerk
Salem, Massachusetts 01970
Dear Sir:
I hand you herewith two copies of Form A, an application submitted by me this day to the Plan-
ning Board of the City of Salem requesting a determination and an endorsement on a plan filed with
said application that Planning Board approval under the Subdivision Control Rules and Regulations is
not required. plan 112---------� —�/-�- �--=--------The land shown on the accompanyinglan is located
at-____- - - -
(insert street and street numbers here)
Signature of Owner -----
---- •------------------------------
--•-
Street Address -----------
City/Town&State_--- ` --- ---------------------
Telephone Number -------- �fS I� C�-----------------------------------------
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FORM A
APPLICATION FOR ENDORSEMENT
OF PLAN BELIEVED NOT TO REQUIRE
APPROVAL
In accordance with provisions of Section II-B, the
applicant must file, by delivery or registered mail, a
Notice with the City Clerk stating the date of sub-
mission for such determination. The notice shall be
attached to two copies of this Form A application.
The notice and both copies of the application must
be "date stamped" by the City Clerk and then one
copy of this Form A, with the Plan, filed with the
Planning Board by the applicant. All notices and
applications shall be typewritten or neatly printed
in ink.
� �d
Salem, Mass., ---- --- ---ZZ---�1----------------
19-1---
To the Planning Board:
The undersigned, believing that the accompanying plan of his property in the City of Salem does not
constitute a subdivision within the meaning of the Subdivision Control Law because (See Sect. II-A and
statespecific reasons) ----------------------------------------- ----------------------------------------------------------
---------------------------------------------------------------------------------------------------. -- —
------------------------------------------------------------------------------------------------------------------------------------------------
and herewith submits said plan for a determination and endorsement that Planning Board approval
under the Subdivision Control L�aw/i of E?quire� i
1. Name of Owner — ---------------------------------------------
Address -------------/_/_-----_-�' -
2. Name of Engineer or Surveyor-____--_� - --------- —
_.
Address .c+ == - - -
3. Deed of property records
in
_�_/ r.+ ." ?S•__ ____-___.______________ Registry
df--Book ---- ,�'- --------------------- Page -----02�1
Location and Description of Property: _ __ ._.f/�7____-._�? �_-____--_--__--__-________________
----------------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------=----------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------'-------------------------------------------------------
- - -------- ------ • ------------------------------------------------------------------------------------
be y{ er with the naes of the Owners
5. All streets and abutting IotSignaturof Ownern on the Plan ge r
of the abuttinglots.
�-
Address --------- -� _ =----- '------------------------- -----
Telephone Number ------- ----------------------------------