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�Nv TOWN OF SOUT14 WINDSOR
INLAND WSTLANOS AMC WATIN COURSSS CEP 26 198i3
APPUCATION IN
South Windsor
THIS APPLICATION, ONCE I " "
1p&A WITLAt= AGENCY ACTION (SEE BACK OF THIS FORM), SHALL AT
Np
REGULARLY SCHEDULED MEETING OF THE AGENCY AT
APPLICATION NO. TOWN HALL.
RECEIVED OAT¢ THIS APPLICATION MUST BE FILMIN TRIPLICATE A'
THE OFFICE OF Ta TOWN CLERK OF SOUTH WINDSOR l
PUBLIC NEARING OATS 12 NOON AT LEAST• 14 DAYS PRIOR TO THE FIRST
(it MWAMBS") REGULAR MONTHLY MEETING DATE. THREE SETS. OF m
COMPLETED APPLICATION OR BE SUEM7TMHE
E TOWN ENGINEEI
PERMIT GRANTED OATS 14 DAYS PRIORST REGULAR_ _
PERMIT DENIED OATS MONTHLY MEETING DATE.
PLEASE PRINT OR TYPE.
1. APPLICANT Q JMZTEL NO.
AOOA
C A
Z OWNER
ADOAEa3 CITY d� STA
3. LOCATION OF PIgCP
NA ES OF ADJAC8N PAOPE NEAS
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LM 1 uay a -Ty
STATE CLEAAL.Y ANO 11MO.Y
S. PUAPOSLS AND OESCAIPTION OF THE PROPOSED ACTIVITY,AND THE TIME MaMENT INVOLVED:
c
ATTENTION: THE APPLICANT UNOE143TAN03 THAT THIS APPLICATION IS TO SE CONSIDERED
COMPl.1_TE ONLY WHEN ALL INFORMATION 3 OOCUMENTS M—WIRED BY THE
AGENCY.MAVE BEEN SUIMITTM,
APPP"OVAL AY ALSO BE NECESSARY FROM THE PLANNING AND ZONING COM-
MISSION.
AN APPLICATION FEE IS REQUIRED. CONSULT TMLIEGULATIONS
(SECTIONS 6.9, 6.9a 'and 6.9b) .
A SIM IS REQUIRED. CONSULT THE:.,gEGULATIONS (SE ON 6.3a) .
� .
SIGNED: h-
( PP 0 cant)
�=s
(Owner)
`/OJLi - .a`� .MesYO l.i1 16vf - ��6A V3.ar k6'am.i.V S`._
6. A,PPLIC.UC HAS HAD MAPS AND PLANS CFMIFIED BY ;SOIL
CUNSERV.4TION SERVICE TO VERIFY COMPLM COMPLLUCE
WITH CONKECTICUT GUIDELINES FOR jUIL EROSION AND
Sr: 1 ENT CUNTROL. ( A6 PER F.Al t80UK, AS A ENDEDED,
AbM PUBLIC ACID 83-388, AS A ENDED.
DATE OF CE TIFICATICAI
7. APPL.ICATICDE 32LFOR ATIOU COMPLIES WITH iGEICY'S
REGULATIONS ( SEGTIL S 7.3., a through j.
8. REQUIRED FEE HAS BEER PAID. ,
DATE RECEIVED _
g. APPLICANT ( OR DESIG&ATED REPk.ESEllTATIVE)HEREBY
"— ATTRsrS THAT A SIG R WILL BE Pc1STED AT THE FOLLOWING
LOCAT IOU(S)
By NAME
ON OR BEFORE ThE 02
QWIXG DATE
SIGNATURE
THIS APPLICATIOM IS FOUND TO BE COMPLETE :AID NOW
QUALIFIES FOR PLACEMENT ON THE AGENCY'S AGENDA:
DATE SIGNATURE
Town Engineer
Agency Sec'y
Agency Chairman
THIS APPLICATION IS INCOMPLETE BECAUSE OF THE FOLLOWING
DIUMBERED IT EMS ( FROM ABOVE ) AS CHECKED BELOW:
1 2 3 4 5
6 7 8 9