HomeMy WebLinkAbout390 Abbe Road (2) °gyp! Town of South Windsor — Health Department
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p 1540 Sullivan Ave., South Windsor, CT 06074-Mailing Address
x 1530 Sullivan Ave,, South Windsor,CT 06074-Office Address
Phone Number; (860)337-6173,Fax Number:(860)644-1930
B100a.A,PPLICA,TION
(for building conversion,change of use,building addition,accessory structure and lot lime cliange)
Standard application review time is 5-10 da s,if soil te-iting b needed,additional time will be required to complete the review process.
Street Address of Proposed Activity/Structure
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Owner Name Mailing Address Telephone -
Applicant Name(if different than owner) Mailing Address -
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Describe the proposed at>ucture or activity with dizrlensions:
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Residential JF Number of existing bedrooms
Nonresidential-Please describe
Property served by on-site well? O N If No,List name of water company
Property served by septic system? 'Y N ,Age of system bate last pumped
Plot plan^attach a scaled drawing showing property lines and dimensions,location and size of existingand proposed
structures, and site features such as driveways,wells and septic systems, drains and water courses. p
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 axed pet'eolation test)axe required for the review of this application.
If the data is N'OT av ailable. you will need to schedule an ap ointineu t with the health department for soil testing.
As property owner or duly authorized representative of the property ogler of the above referenced property,i agree to allow the
health department staff to a er the above referenced property as part of this B 100a application review process.I further agree that
this authorization t enter the subs roperty may extend through a period of time ending with,the final B.100a application
a royal and affir.1 molt with to si hire below. RECEIVED
Applicant Signature- Date:
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FOR OFFICE USE ONLY: SOUTH WINDS R
HEALTH DEP .
Approved:L/ NBy: E Date: ��(
Comments/Conditions:
May 2011
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APPROVED
TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
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