HomeMy WebLinkAboutApplication - Strawberry Lane TOWN OF SOUTH WINDSOR
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WATER POLLUTION CONTROL AUTHORITY
APPLICATION FORM
Application No.
Date Received
Date Scheduled For
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Applicant C, G L E 6Al A k 1> JA- C-0 P.9, �S Q
Address o o Telephon No. 3 6 - 6q-4- d 1Z 1
Owner of Record on Land Records �r deo
Owners Address 5FF. AppL-le-AA)r tn1FD L�r 38 U�L1t3Z p �Za�og.s. �56?
Property Description: &T
Assessor's Map # I 0op Sh Parcel # � Vol. Lo r z VD LPage Z®
Project Title: �-r
Inquiries to be uected to: (narnif, address, telephone no.) 66HOLER ,
p o -
Approvals Previously Received (Check) IWA _ X P & Z _ (X ZBA X
Purpose of Application: (Check all that apply)
1. Sewer Extension/Connection -- Residential Use
a. Subdivision
b. Single Unit
c. Other X xplain rY B cal AJ
d. Type o Approval: Concept Final X
2. Sewer Extension/Connection -- Industrial/Commercial User
a. New Connection
b. Request to Increase `owKate
c. Change in Nature of Waste Discharge
d. Other Explain
e. Type o Approval: Concept Final
3. Appeal of Sewer User Charge
a. Residential
b. Industrial/Comme c
4. Sewer Assessment
a. Establish Sewer Assessment
b. Appeal of Sewer Assessment
c. Change in Use of Property
5. Regulatory Appeal ; Explain
6. Other . Explain
A t s b igna a Date
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weer s i e ate
(See Reverse Side for Application Submittal Procedures)
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