HomeMy WebLinkAbout56 Cornerstone Drive - WPCA Application TOWN OF SOUTH WINDSOR
WATER POLLUTION CONTROL AUTHORITY
APPLICATION FORM
Application No.
Date Received
Date Scheduled For
Applicant
Address / J - l= - �, Telephone No. - > "
Owner of Record on LandRecords t L LG
Owners Address . 16ex
Property Description:
Assessor's Map # _I 0 Parcel # d12 Vol. Page S
Project Title:
Inquiries to be Directed to: e, aT'l
ess, teleph ne no.)
l
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
c. Other Explain
d. Type o Approval: Concept Final
2. Sewer Extension/Connection -- Industrial/Commercial User
a. New Connection
b. Request to Increase ow to
c. Change in Nature of Waste Discharge
d. Other Explain
e. Type o Approval: Concept Final
3. Appeal of Sewer User Charge _
a. Residential X
b. Industrial/Commerctal
4. Sewer Assessment
a. Establish Sewer Assessment
b. Appeal of Sewer Assessment
c. Change in Use of Property
5. Regulatory Appeal ; Explaindl) -&z,47t BBC- L'-�✓�2
6. Other Explain
� ���.'-tit✓ .�tt���t� L�y2�i
J
A Pli_caj.nt's §1 nature Date
Lac v kI-L
ner s Sig#ature Zi Date
(See Reverse Side for Application Submittal Procedures)
Inasolwc4lapplication
111261%
TOWN OF SOUTH WINDSOR
WATER POLLUTION CONTROL AUTHORITY
APPLICATION FORM
Application No.
Date Received
Date Scheduled For
Applicant , _ u L!cG �t�2 �
Address s '����� Telephone No. �.
Owner of Record o Land Records z,t ,1 .�ETTI�-,,
/- /C
Owners Address L.z . /e)x rz) , , . 7- _
Property Description: _
Assessor's Map # Parcel # Vol. Page I
Project Title:
Inquiries to be irected jo: (name address, telephone no.) u-,
o
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 K
c. Other Explain
d. Type o Approval: Concept Final
2. Sewer Extension/Connection -- Industrial/Commercial User
a. New Connection
b. Request to Increase ow to
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/Commer—c al
4. Sewer Assessment
a. Establish Sewer Assessment
b. Appeal of Sewer Assessment
c. Change,in Use of Property
5. Regulatory Appeal �_; Ex.pIain
6. Other Explain
a4t s mature" ate
Zit mtGar
Owner's nature Date
(See Reverse Side for Application Submittal Procedures)
I usso/WPGVapplicadon
111261%