APPLICATION FOR APPROVAL OF PRELIMINARY PLAN
File one completed form with the Planning Board and one copy with the Town Clerk in accordance with the requirements of Section IV-A.
To the Planning Board of the Town of Lenox:
The undersigned herewith submits the accompanying Preliminary Plan of property located in the Town of Lenox for approval as a subdivision as allowed under the Subdivision Control Law and the Rules and Regulations Governing the Subdivision of Land of the Planning Board in the Town of Lenox.
1. Name of Subdivider:________________________________________
2. Name of Engineer:
3. Name of Land Surveyor:_____________________________________________________
4. Deed of property recorded in Berkshire Middle District Registry of
Deeds in Book_________________ Page__________________
Form B Continued
5. Location and Description of Property:______________________
(Signature of Owner)
A list of the names and addresses of the abutters of this subdivision attached.