HomeMy WebLinkAboutApproved Design 56 Wendy Drive a dre
'�°�°�" '�,< -' Town of South Windsor — Health Department
1540 Sullivan Ave., South Windsor, CT 06074—Mailing Address
i 1530 Sullivan Ave.,South Windsor, CT 06074—Office Address
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SOb[Q Phone Number: (860)337-6173, Fax Number: (860)644-1930
B100a 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 com lete the review process.
Street Address of Proposed Activity/Structure
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Owner ame Mailing Address Telephone
Applicant Name(if different than owner) Mailing Address Telep noh e
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Describe the proposed structure o ctivity with a •mensions:
Residential ✓Number of existing bedrooms
Non-residential Please describe
Property served by on-site well? a&
If No,List name of water company_ •�
Property served by septic system?0 N Age of system4VY Date last pumped h u j
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 for soil test._
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>>ro\,iI and affirm such with rny signature below.
Applicant Signature: Date:
FOR OFFICE USE ONLY;
Approved ti' i\' By: Date:
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Comments/Conditions:
ell
May 2011
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FILE NUMBER! --
Y PRO*GRE"S`S FILE NAME:
NOTES ADDRESS:
TOWN:
DATE TIME ACTION INITIALS DATE
To D E TIME AM
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O E E-M IL ADDRESS SIGNED
PHONED CAC RETURNED SEEYOTO❑ ACy4J(OjALL❑ WAS IN ❑ URGENT❑
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