Lenox Town Hall
6 Walker Street, Lenox, MA 01240
ph: 413-637-5500
Form A
APPLICATION FOR A DETERMINATION OF PLANNING BOARD JURISDICTION
AND FOR ENDORSEMENT THAT PLANNING BOARD APPROVAL UNDER SUBDIVISION CONTROL LAW IS NOT REQUIRED.

File one completed form with the Planning Board and one copy with the Town Clerk in accordance with the requirements of Section III.
                                                        
Lenox, Massachusetts ________________________________ (Date)
                                                        
To the Planning Board of the Town of Lenox:
                                                                        
The undersigned, believing that the accompanying plan of his property in the Town of Lenox 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.  Plan Prepared by:
                                                
        Registered Land Surveyor, Engineer)
                                                
                                                        
        Entitled: _____________________ Dated:____________
                                                
3.  Deed of Property Recorded in Berkshire Middle District
                                                
        Registry of Deeds in Book _____________ Page_______________
                                                
4.  Location and Description of Property:
                                                
5.  Applicant believes that Planning Board approval is not required for the following reasons:
                                                
a. The division of land shown on the accompanying plan is not a subdivision because every lot shown thereon has the frontage and area required by the Town's Zoning By-Law, and is on a public way, namely, or a private way, namely, which was approved by the Planning Board under the Subdivision Control Law as a subdivision entitled

b. The land shown on the accompanying plan is not a subdivision for the following reason(s):

        ____________________________________________
        (Signature)
        
        ____________________________________________
        (Address)