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OFFICE OF
PLANNING BOARD
Town Of Belchertown
P.O. Box 964
Belchertown, Massachusetts
01007
FORM B
APPLICATION FOR APPROVAL OF A PRELIMINARY
PLAN
Belchertown
Planning Board
Date: , 20
File
a complete application form and 10 prints of the plans with the Planning
Board. Include with the application to
the Planning Board all other necessary and supporting information and
documentation. File one complete
application and the fee assigned by the Planning Office with the Town
Clerk. Submit 2 prints of the plans and
an application directly to the Board of Health. Include in your submission to the Board of Health all soil and
percolation information you have. This
procedure is according to the requirements of Chapter 270, Article III, Section
270-17 of the Code of the Town of Belchertown (Subdivision Regulations) and
according to MGL c. 41, §81S.
To the Planning Board:
The
undersigned submits the accompanying Preliminary Plan of property located in the Town of Belchertown for approval as
allowed under the Subdivision Control Law Ch. 41, Sec. 81, M.G.L. and the Rules
and Regulations governing the Subdivision of Land in Belchertown,
Massachusetts.
1.
Applicant
Address Telephone
2.
Owner
Address Telephone
3.
Engineer
or Surveyor
Address Telephone
4.
Property
deed reference in the Hampshire Registry of Deeds, Book __________ , Page
________
-continued-
5.
General
description of the plan:
a.
Plan
Title
b.
Location
of the property
c.
Total
acreage of tract
d.
Number
of lots allowed by zoning
e.
Number
of lots proposed
______________________________
Signature
of Applicant
______________________________
Signature
of Owner
_______________________________________________________________________________
For Office Use
Planning
Board Fee Assignment and Signature:
Cost
$_____________ Signature: _________________
Received
by Board of Health:
Date:
_____________ Time: _____________________
Signature: ____________________________________
Received
by Town Clerk:
Date:
_____________ Time: _____________________
Amount
Received: _____________________________
Signature: ____________________________________