HomeMy WebLinkAbout239 Lawrence Road - WPCA Application TOWN OF SOUTH WINDSOR
l WATER POLLUTION CONTROL AUTHORITY
RECEIVED APPLICATION FORM
MAR 3 o TOO
Application No.
P��, Date Received
DEPT Date Scheduled For
Applicants p s S
Addr 3 0
w CEO- Telephone $6yj m [��g_per
Owner of Record on Land Records
Owners Address-�� Ly
Property Description.
Assessor's Map# Parcel# Vol. Page
Project Title: 5!a L 4, w tz_k)0.g- I
Inquiries to be directed to: (Name,Address,Phone)
Approvals Previously Received: (Check) IWA P &Z ZBA
Purpose of Application: (Check all that apply)
1. Sewer Extension/Connection—Residential Use
a. Subdivision
b. Single Unit _ X
c. Other _Explain Q ol CEs rtS l2 1 S C�W-iG p-.cS cql
d. Type of Approval: Concept _ (� Final
2. Sewer Extension/Connection—Industrial/Commercial User
a. New Connection
b. Request to Increase Flow Rate
c. Change in Nature of Waste Discharge
d. Other Explain
e. Type of Approval: Concept Final
3. Appeal of Sewer User Charge
a. Residential
b. Industrial/Commercial
4. Sewer Assessment
a. Establish Sewer Assessment
b. Appeal of Sewer Assessment
c. Change in Use of Property
5. Regulatory Appeal : Explain
6.Wth E lain
s Si a re Da
Ail D
Owner's Signature Da
(See Reverse side for Application Submittal Procedures)