HomeMy WebLinkAbout476 King Street (3) Town of South Windsor — Health Department
1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address
1530 Sullivan Ave., South Windsor, CT 06074—Office Address
°50"`"h Phone Number: (860) 337-6173, Fax Number: (860) 644-1930
APPLICATION FOR APPROVAL TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Application/Permit#:
To the Director of Health,Town of: South Windsor Date: 7/13/18
Application is hereby made for an approval to construct a subsurface sewage disposal system for a:
Residential Building
(Residential Building,Restaurant,Retail Building,etc.)
located at: 476 King Street
(Street Address,Lot Number,Subdivision Name,Map,Block,Lot,etc.)
New System Addition Repair X Other
Owner Lusarida Property Management Address 127 Grandview Dr, Glastonbury Tel.No. 860-899-6266
Installer Arthur Breault Address 77A Woodland St, Manchester Tel.No. 860-432-5996
Installer Li �No, 5 9
_ Z
In accordance with detailed information stated below:
Application fee paid $100.00 Signed �,GG
(Owner or duly authorize representative)
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GENERAL INFORMATION
Soil Tests Conducted(Date): Lot size 47,044.8 sq.ft.
Area of Special Concern(Y/N): If yes,Reason(s):
RECEIVED
Basis of Design(#of Bedrooms,Restaurant Seats,Building Size,etc.): 3 Bedrooms JUL 2 5 2018
Engineered Plan Required(Y/N): N If yes,Name of Engineer: SoUTH VAiDSOR
TH DEPT
Address of Engineer:
Design Plan Approved(Y/N): Date of Approved Plan: Revision Date:
Type of Water Supply If well,has location been approved(Y/N):
Well Driller's Name: Address:
OFFICE USE ONLY
Approval to Construct issued by: Date:
(Director of Health or Registered Sanitarian)
Signature: Title: