HomeMy WebLinkAboutApplication 51 Green Lane � Kd Town of South Windsor — Health Department r �
1540 Sullivan Ave.,South Windsor,CT 06074--Mailing Address
1530 Sullivan Ave.,South Windsor,CT 06074—Office Address
4f ydso�c�a�� Phone Number:(860)337-6173,Fax Number:(860)644-1930
B1.00a APPLICATION
(for building conversion,change of use,building addition,accessory structure and lot line change)
Standard application review time is 5-10 days,if soil testing is needed,additional time will be required to complete the review rocess.
Street Address of Proposed Activity/Structure
Owner Name Mailing Address Telephone
Applicant Name(if different than owner) Mailing Address Telephone
Describe the proposed structure or activity with dimensions:
Residential Number of existing bedrooms
Non-residential PIease describe
Property served by on-site well? Y (9) If No,List name of water company
Property served by septic system?o N Age of system Date last pumped l
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
ro osed 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 for soil testing.
As property owner or duly authorized representative of the property owner of the above referenced property,I agree to allow 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 of time ending with the final B 100a application
a roval and affirm such with my signature below.
AV
Applicant Signature: Date: 7
�' .� RECEIV D
FOR OFFICE USE ONLY: NOV 0 8 2 16
Approved: N By: lQ Date:�f I , SOUTH WIND OR
E T.
Comments/Conditions: U U
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May 2011
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ZONING COMPLIANCE FOR SMALL STRUCTURES
(Sheds and detached decks 200 sq. ft. and smaller)
Address of Proposed Structure: ,�� Zone:
Name of Owner: (TS'( GIS PIN:
Phone Number: —S3-4/3 Application #:
1. Name of Applicant: � in �'YPr�_
Address: �Tf"epn ,Ln S29z �;U Ocu
Phone Number:
2. Structure cannot exceed 200 square feet.
TYPE OF STRUCTURE: SHED DECK (not to exceed 30"from grade)
DIMENSIONS OF PROPOSED STRUCTURE: ✓ a r
3. A Class D survey must be submitted with the application showing the property lines, all other
buildings and the location of the proposed structure.
4. Is the property served by a septic system? �es No If yes, the applicant must
complete and submit a B100a Application to the Health Department for review and approval
The undersigned hereby permits Town staff to enter onto and inspect this property during
reasonable hours for the purpose of reviewing this application and to determine final compliance
once construction is completed,
I, the undersigned, acknowledge that the above information is true to the best of my knowledge
and that the above requirements are understood.
Applicant Signature: Date:
Owner Signature. Date:
Reviewed and approved by: Date:
Zoning Enforcement Officer
Reviewed and approved by: im,,a&
Date: I
Environmental Health Officer RECEIVED
cc: Assessor NOV 0 `l01
Building File
SOUTH WINDSOR 04/15h4
HEALTH DEPT.