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HomeMy WebLinkAboutSeptic Correspondence 130 Berle Road South Windsor Health Department B 100a application (for building conversion, change of use, building addition, accessory structure and lot line change) Address of proposed activity street number T(U0 , 130 1 e V If- Owner Name Address telephone Applicant name &address if different from above telephone Describe the proposed structure or activity with dimensions (e.g. _"addition with bedrooms, bathroom, family in ground/below ground pool, deck,winterizing porch) Residential V Number of existing bedrooms N Non-residential Please describe Property served by on-site well? Y N Propert y served by public water? Y N Plot plan-attach a scaled drawing showing property lines and dimensions, location and size of existing and proposed structures, and site features such as driveways, wells and septic systems, drains and water courses. Building plan-attach a sketch/floor plan of the proposed structure, addition or renovation showing existing and proposed rooms with door and window locations. Soil test data(deep test pits and percolation test) are required for the review of this application. If the data is not available, you will need to schedule an appointment with the health department. As property owner or duly authorized representative of the property owner of the above referenced property, I agree to permit the health department staff to enter the above referenced property as part of this B 100a application review process. I further agree that this authorization to enter the subject property may extend through a period time ending with the final B 100a application approval and afB m such with my s' nature low. Applicant Signature �- Date OFFICAIL USE ONLY Elec c APPLICATION FOR BUILDING PERMIT Plu i # — HV C Date: I ID tag` Sp kl r## APPROVALS Estimated Cost $-75ya . 9 y Buil ing COMPLETE RED BOXED AREAS Permit Fee $ pD Engineering TYPE OR PRINT ONLY Occupancy Fee $ fo•asp Affidavit prafor CO. SIGN ON REVERSE SIDE Eng.Insp. Fee $ Total Fee $ JrS.0O TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR,CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant u �'1Ci�n Location of Work_ Nome.. Lot No. Applicant's Address 130 3e i� Tel.#_ SLtS �i3�- IOU Town__ �bv+ ��VX Qr Zip biaar'7 Lic.# s%O(o©8884+� Owner T v-t Architect Owner's Address 130 lReerld Architect's Address Sq. Ft. New Area: 1st FI. 2nd FI.Zip 3rd FI. Total New Area Zip Purpose of this permit Licot� SI nv� ,�5.�✓{- ,�,�i�� CityWa ter❑ Well❑ Septic System Sewer❑ Ins: HO SP Cert. Area Basement Garage Approved by Date Use Group Construction Type Revised 6/02 I 1 1 S1 AL.A$7 7 QUA BODEGA BAY BOW3AX- -- BOD )EGA BAY BLACK DOOR 1 1 2SPALA547 QUA:BODAGE HAY NICKEL.,. STANDARD PAN, S7P-BB3040-NL 1 i L.S.PALA88 9 QUA:DC-P,BB-NL N I CIS DOOR NICKEL DOOR CROWN BD-BAY HIS ORDER IS ALSO SUBJECT TO THE STANDARD TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS FORM.PURCHASER 2, 399 . 00 CKNOWLEDGES THAT HE/SHE HAS READ,UNDERSTANDS AND AGREES TO BE BOUND BY THESE TERMS AND CONDITIONS. DEPOSIT CANCELLATIONS NOT ACCEPTED CHECK CASH= 0. 00 'RESTON TRADING POST twill expedite special orders VISA ❑ MC ❑ DISC ❑ OTHER ❑ wt is not responsible for fac> ry delays. s ` ' have received a copy of this Purchase Agreement. 0. 00 D.S.NO. k LESS MASTER VI 2,542. 94 0 . 00 REC'D BY