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City of Salem, Massachusetts Planning Board Waiver Request To the Planning Board: The undersigned represent(s) that he/she is (are) the owner(s) of a certain parcel of land located at which he/she propose(s) to divide into lots, as depicted on the accompanying plan and hereby petition(s) the Planning Board to waive, to the extent shown on the submitted plan, the frontage requirement of the Subdivision Control Law, pursuant to the authority of M.G.L Chapter 41 Section 81R for the following reasons: Signature of Address: _ _ Telephone Number: Date: _ CITY OF SALEM PLANNING BOARD ---PAGE BREAK--- NOTICE TO BE ATTACHED TO WAIVER REQUEST City Clerk Salem City Hall 93 Washington Street Salem, Massachusetts 01970 Dear Sir/Madam: I hand you herewith sixteen (16) copies of Waiver Request, an application submitted by me this day to the Planning Board of the City of Salem requesting waiver of frontage requirements of the Subdivision Control Law. The land shown on the accompanying plan in located at in Ward Signature of Street City, State, & Telephone