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Home My WebLink About2017-5-25 - 160 Chapel Road - B100a Application 6IA-- Town of South Windsor — Health Department p o 1540 Sullivan Ave., South Windsor,CT 06074—Mailing Address Z ti 1530 Sullivan Ave., South Windsor, CT 06074—Office Address 4"/y .a44 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 8PPlication 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 Pr posed Activity/Structure Owner Ine Mailing Address Telephone Applicant Name(if different than owner) Mailing Address Telephone Describe the proposed structure or activity with dimensions: MAY Residential Number of existing bedrooms SOUTH WINDSOR HEALTH.DEpT Non-residential Please describe Property served by on-site well? f�Y N If No,List name of water company Property served by septic system?ON Age of system /�f Date last pumped 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 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;i period of time ending with the final B100a application approval and affirm such i m si ature below —,_.. Applicant Signature: Date: FOR OFFICE USE ON Approved: N By: / /S ate: 3� / _ Comments/Conditions: �G6 May 2011 SURVEY( OF LOT NO, PROPERTY OF FUSE&IO �S'.IL M - �, I/- Z)4 - ml)lem Cove,0,6 Ro AND LOCATED AT Na. CONN. SCALE " = 40 DATE:- /11,4 Y /9 7 7 =+ --�- W � 1 I Iv s O N V W J-7 TS7' W /e.mi lX1 J Pv Ylc 0-1 3 49•s' H' I Bois►f� 2 9!s'`�0� v / 3S So'Rui • 371 - 'o11 %N /P.s �%T , ev laoo"h -_ 3¢ P J / �DC' Oa fun? 10%7- Al 5r S--oo-o o syet�'Y�. Coy` Town of South Windsor— Health Department 1540 Sullivan Ave., South Windsor, CT 06074 — Mailing Address s 1530 Sullivan Ave., South Windsor, CT 06074 —Office Address Phone Number: (860) 337-6173, Fax Number: (860) 644-1930 B100a APZMn, ION (for buildin aversion, change of use, buildinccessory structureand lot line change) Standard a lication review tt is 5-10 da s, if soil testin is al time will be required to complete the review process. Street Address ofPrdposed Activ• ucture Owner NAne Mailing Ad[ r Telephone Telephone Applicant Name (if different than owner) Mailing Address Describe the proposed structure or activity with rlimPneinne• a- s �((� — s y s,�.�,.,,� R r__E� ■Icy, Reside 3� jy1 evv\ MAY SOUTH WINDSOR Non-ri HEALTH DEPT Propel 310 `�Z -' ��.,�! r company Propel Date last pumped Plot pl l A CL �',F,� � 1 (0 ' L structui ns, location and size of existing and proposed ]rains and water courses. Buildh tion or renovation showing existing and rp oposc Soil If the d ew of this application. , prop th the health de artment for soil testing. he health dh above referenced property, I agree to allow the this auth )a application review process. I further agree that 8 1'DV8 ova ae ending with the final B100a application Applic: Date: FOR O Appro's fl ate• % Comments/Conditions: SURVEY OF LOT NO. PROPERTY OF EUSEWID S.lL M :' IL /)A /I�IfI.c, r,A No. CD.PI�E`IR4 AND LOCATED AT CONN. SCALE 1" = 4 0DATE:- M.•4 }� / 9 % 7 =. �''/� �Q�� /� �/U•QG�Li7s S 's"S d oD - Da /E --v.- I Lim, ID ,1 Q Ct7��On •�J �_ t . o �Z, e Ser � v 6 h'a/e, CA '�" � 'il.i:: ;t- ...D,�r; .2^-6S� T►'N�,c/ie,1• /poo GxI p4rih. vl /y,,fc3-7 � 40.y� 4 R S ,\_ 9)^ 1 / S So/R✓;/��.�• 37 1 47 Bain F�9 zgs rv�.` � TrD j I ��FE� a9Q ,"�E #tL 42•4 _ 30 N_� •'�� fD V•4'T'r1-?�rq f +._�� G;II oi.. ✓o�7�.rP. r� C. onTovrRi� r.:s��+JJ• / /t!d 7/E t� ' 82 -30-Oo • .� �i. g� �D �7�4/ ,14cY�. coy` �10 Town of South Windsor — Health Department 1540 Sullivan Ave., South Windsor, CT 06074 — Mailing Address ti 1530 Sullivan Ave., South Windsor, CT 06074 —Office Address Phone Number: (860) 337-6173 Fax Number: (860) 644-1930 B100a APPLIC IQN (for buildin nversion, change of use, building a inn, accessory structure and lot line change) Standard application2reviewoi 5-10 days, if soil testin is ed, additional time will be required to com lete the review process, treet Address Activ' ueture Owner ue Mailing Ad r , 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 Please describe Property served by on -site well? YN Property served by septic system? �N If No, List name of water company SOUTH WINDSOR Wh-gLTH :DEPT Age of system A Date last pumped 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 testin . 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 approval and affirm such nth my sip -nature below. Applicant Signature: Date: FOR OFFICE USE ON�,.'/. Approved: 5N By: / r. ate: 34 Comments/Conditions: SCANNED