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FORM C APPLICATION FOR TENTATIVE APPROVAL OF DEFINITIVE PLAN In accordance with the provisions of Section III-A of the Salem Subdivision Regulations the applicant must file, by delivery or registered mail, a notice with the City Clerk stating the date of the submission for such determination. The notice shall be attached to fifteen (15) copies of this Form C application. The notice and copies of the application must be “date stamped” by the City Clerk and then fifteen (15) copies of this Form C, with the Plan, filed with the Planning Board by the applicant. All notices and applications shall be typewritten or neatly printed in ink. Salem, To the Planning Board: The Undersigned herewith submits the accompanying Definitive Plan of property located in the City of Salem 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 City of Salem. 1. Name of Subdivider 2. Name of Engineer or 3. Deed of property recorded in Registry, Book Page 4. Location and Description of 5. All streets and abutting lot lines shall be shown on the Plan with the names and addresses of the abutting Owners. Signature of Owner Address Telephone Number A list of the names and addresses of the abutters of this subdivision is attached, which shall be attested to by the surveyor. Verification will be made by the Planning Board. CITY OF SALEM PLANNING BOARD ---PAGE BREAK--- NOTICE TO BE ATTACHED TO FORM APPLICATIONS See Form applications for complete instructions for filing. All insertions shall be typewritten or printed neatly in ink. City Clerk Salem, Massachusetts 01970 Dear Sir/Madam: I hand you herewith sixteen (16) copies of Form C, an application submitted by me this day to the Planning Board of the City of Salem requesting a tentative approval, by the Planning Board, of a definitive plan filed with this application. The subdivision shown on the plan is tentatively designated as and is located on streets now and/or tentatively known as (insert streets and street or lot in Ward Signature of Owner Street City/Town and State Telephone Number