HomeMy WebLinkAboutMisc Correspondence 65 Miller 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
Owner lame Address telephone
Applicant name &address if different from above telephone
Describe the proposed struc �eck,
vity with dimensions (e.g. _"addition with bedrooms, bathroom, family
in ground/below ground pooterizing porch)
Residential Number of existing bedrooms
Non-residential Please describe
Property served by on-site well. Y N Property 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 revieyv process. I further agree that this authorization to enter the subject
property may extend through',d perio final of time ending with the B 100a application approval and
affirm such with my sIgnatur6below/
Applicant Signature Date 7 10 ,d
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Soutn VVintlsor
BUILDING DEPARTMENT
j iHIE €sssit iisv iJENt: TOWN Of -WUTH WINDSts.
-his c(O'tifled that this plan and specifications are tru.
:opies-of the proposod-p4 0149 or alterations to ba
arected at -
Street
together with 4amendments stated In oatlon and
filed-with plan an I agree to comply with all zoning,
BuildinAu
uchorders-as-$hall be -
issuedrt ent during pendency
rf this suar" of a buildingpermit.igned
'his plt to the eonditl t 4 _
,rders and ordinances regulating building Hall be
'!r:piied with.
ondttionally Approved These flied wlttf
+-"Iling 1,1spector clerk
CERTIFICATION OF ZONING COMPLIANCE
Proposed building(s), use(s)and/or structure(s)
`7
� tq",Yt2 a as shown on this plan appear(s) to be in
conformance with current South Windsor
regulations. Variances and special exceptions
may apply.znll in,310
14-r
/�/� Date
F 'f' -
Zoning Enforcement Officer