Application For Endorsement

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FORM A
APPLICATION FOR ENDORSEMENT
OF PLAN NOT REQUIRING APPROVAL
Date:______________
[File two (2) completed forms with the Planning Board, with the required filing fee.]
The undersigned, believing that the accompanying plan of his/her property in the Town of Ashby 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 ______________________________________________________
Address: _________________________________________
2.
Name of Owner (if different than Applicant)______________________________
Address: _________________________________________
3.
Name of Surveyor/Engineer___________________________________________
Address: _________________________________________
4.
Deed of Property recorded in the Middlesex Southern District Registry of Deeds In Book
___________
Page
Probate Court Docket No. ________
___________
5.
Property Address:______________________________________
Assessors Map/Block/Parcel:_____________________________
Zoning:______________________________________________
Number of lots being created: ____________________________
6.
Is this property classified by the Board of Assessors under Chapter 61, 61A, or 61B?_______
Signature of Applicant
Signature of Owner
__________________________
_______________________________
Town of Ashby Planning Board,
895 Main St. Ashby, Massachusetts 01431
Tel. (978) 386-2427 x.20

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