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TOWN OF SOUTH WINDSOR
INLAND WETLANDS AND WATER COURSES OCT 14 19
10
APPLICATION04.a.tL
INLAND WETLANDS AGENCY ACTION THIS APPLICATION SHALL BE RECEIVED BY THE
INLAND WETLANDS AGENCY AT THE REGULAR-
LY SCHEDULED MEETING ON THE SECOND MON-
APPLICATION NO. DAY OF THE MONTH AT THE TOWN HALL.
RECEIVED DATE d �� THIS APPLICATION MUST BE FILED IN TRIPLICATE
PUBLIC HEARING DATE AT THE OFFICE OF THE TOWN CLERK TOWN OF
(if necessary) SOUTH WINDSOR, AT LEAST TEN DAYS PRIOR TO
COMPLETED APPLICATION THE REGULAR MEETING DATE.
PERMIT GRANTED DATE J/���1�� A SET OF PLANS MUST BE SUBMITTED TO THE
TOWN ENGINEER AT LEAST TEN DAYS PRIOR TO
PERMIT DENIED DATE THE REGULAR MEETING DATE.
PLEASE PRINT.
1. APPLICANTy � TEL. NO. ✓� �—� t'
ADDRESS Zed /���e3 A ,pJh� CITY & STATE y d
2. OWNER- TEL. NO.
ADDRESS CITTY & STATE
__
3. LOCATION OF PROPERTY Zhj2 � � /
NAMES OF ADJACENT PROPERTY OWNERS
STATE CLEARLY AND BRIEFLY
5. PURPOSES AND DESCRIPTION OF THE PROPOSED ACTIVITY,AND THE TIME ELEMENT INVOLVED:
a ,
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ATTENTION: THE APPLICANT UNDERSTANDS THAT THIS APPLICATION IS TO BE CONSIDERED
COMPLETE ONLY WHEN ALL INFORMATION & DOCUMENTS REQUIRED BY THE
AGENCY HAVE BEEN SUBMITTED.
APPROVAL MAY ALSO BE NECESSARY FROM THE PLANNING AND ZONING COM-
MISSION.
A FIFTEEN DOLLAR ($15) APPLICATION FEE IS REQUIRED, AND IT MUST BE SUB-
MITTED TO THE AGENCY AT ITS REGULAR MEETING.
(
° .
SIGNED:
(Applicant)
Revised 3/78 (Owner)