HomeMy WebLinkAbout2020-3-9 - 100 Long Hill Road - B100a ApplicationTown of South Windsor —Health Department
1540 Sullivan Ave.,South Windsor,CT 06074 —Mailing Address
1530 Sullivan Ave.,South Windsor,CT 06074 —Office Address
Phone Number:(860)337-6173,Fax Number:(860)644-1930
3100a APPLICATION
(for building conversion,change of use,building addition,accessory structure and lot line change)
Standard application review time is 5-10 davs.ifsoil testing is needed,additional time will be required to complete the review process.
MO -C EJN ('1 H‘i LL.£29 4.7/3
Street Address of Proposed Activity/Structure
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Owner Name Mailing Address Telephone
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Mailing Address I my a z Li TelephoneApplicantName(if different than owner)
Describe the proposed structure or activity with dimensions:
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Residential Number of existing bedrooms
[/W Please describe Q lye/L Dm-(3x {’(hNon-residential J 0 J
Property served by on-site well?N If N0,List name of water company
Property served by septic system.y N Age of system Date last pumped\
Plot plan i 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/door 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,l agree to allow the
health department staff to enter the above referenced property as part of this B l()0a application review process.l further agree that
this authorization to enter the subject property may extend through a period of time ending with the final B10011 application
approval and affirm such with my signature helow.
Applicant Signature:O \i‘.i i WC)Rf/Date:
ig f U (1 llg LE)
FOR OFFICE USE ONLY:
Approved:Y N By:Date:
Comments/Conditions:
FEE PAID:CHECK #DATE PAID:
ZONING COMPLIANCE FOR SMALL STRUCTURES
(Sheds and detached decks 200 sq.ft.and smaller)
Address of Proposed Structure:I’l7>'(“‘r WV [:1 #1 é {’Ei‘vm Zone:
Name of Owner:UN (76??)[SLAM/C "i (ZoS GIS PIN:
Q’é Ca ”AryWg a éZf"1_~Phone Number:Application #:
1.Name ofApplicant .....A 8K GI <5 45L b
Address:[ac-g ~—dam}(q ,L/fcc.i (o&1>
Phone Number:5G.0 hSTi?"éE ZSWZ.
2.Structure cannot exceed 200 square feet.
TYPE OF STRUCTURE:a/SHED DECK (not to exceed 30”from grade)
DIM ENSIONS OF PROPOSED STRUCTURE:J o a Qt
3.A Class D survey must be submitted with the application showing the property lines,all other
buiidings and the location of the proposed structure.
4.Is the property served by a septic system?V/Yes No If yes,the applicant must
complete and submit a BlOOa 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 formation is true to the best of my knowledge
*****************************************************************
Reviewed and approved by:Date:
Zoning Enforcement Officer
Reviewed and approved by:Date:
Environmental Health Ofhcer
cc:Assessor
Building File
04/15/14
and that the above reqUIrements a derstood
Applicant Signature:Date:g?M1 )%W
Owner Signature:fK€£w r\\it \/Date:
STATE W GUNNtu "w ‘
EXSWNS BUR ENG
’4'msm‘e SHED'v aa REMOVE