Lenox Town Hall
6 Walker Street, Lenox, MA 01240
ph: 413-637-5500
Form C
APPLICATION FOR APPROVAL OF DEFINITIVE PLAN

File one completed form with the Planning Board and one copy with the Town Clerk in accordance with the requirements of Section IV-B.
                                                                
Lenox, Massachusetts
                                                        
____________________________ (Date)
                                                        
To the Planning Board of the Town of Lenox:
                                                        
The undersigned herewith submits the accompanying Definitive Plan of property located in the Town of Lenox for approval as a subdivision under the requirements of 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_______________
                                                
        5. Location and Description of Property:_______________________
                                                
        ________________________________________________________

       ________________________________________________________
                                                
        _______________________________
        (Signature of Owner)
                                                
        _______________________________
        (Address)
                                                
        A list of the names and addresses of the abutters of this subdivision is attached.