Lenox Town Hall
6 Walker Street, Lenox, MA 01240
ph: 413-637-5500
Form B
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.

Lenox, Massachusetts
                                                        
_________________________ (Date)
                                                        
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:________________________________________
                                                
        Address:_____________________________________________________
                                                
        2. Name of Engineer:
                                                
        Address:_____________________________________________________
                                                
        3. Name of Land Surveyor:_____________________________________________________
                                                
        Address:_____________________________________________________
                                                
        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)
                                        
        ___________________________________
        (Address)
                                                
        A list of the names and addresses of the abutters of this subdivision attached.