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FORM K SUBDIVISION COMPLETION CERTIFICATE
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Ipswich, MA_______________________, 19___
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Name of Subdivision_______________________________________________
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Owner_____________________________________________________________
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Date of Application_______________________________________________
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Date of Approval or other action by Planning Board________________
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Performance Guarantee_____________________________________________
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__________________________________________________________________
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__________________________________________________________________
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__________________________________________________________________
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Way Completed to Satisfaction of:
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Public Works Department By__________________________________
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Date:_________________t
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Sewer Division By_______________________________________
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Date:_________________
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Water Division By_______________________________________
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Date:_________________
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Board of Health By_______________________________________
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Date:_________________
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Electric Department By__________________________________
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Date:_________________
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Release of Bond or Security Approved by the Ipswich Planning Board
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Date:_________________ By_________________________, Chairman
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By_________________________, Clerk
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Approved as to Form:_________________________
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Date:____________________
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TOWN OF IPSWICH PLANNING BOARD
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Checklist for Approval Not Required Plans (Form-A)
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(Ch. 41, Section 81P)
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(This checklist is for Planning Board use only; however the applicant may find it useful for plan preparation.)
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Date Plan Filed:_______ (+ 21 Days) Final Decision Due on:_______
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Refer to Planning Board Subdivision Rules and Regulations Section III
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(Checked-Off Items are Complete, Circled Items are Incomplete, or
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N/A - Item Not Applicable)
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