HomeMy WebLinkAboutAPP S
Town of Montville Inland Wetlands Application # a�O1 W It
C 1,0 (o,
APPLICANT INSTRUCTIONS: All applicants must complete this application form. The Commission will notify
the applicant of any additional information that may be required and will schedule a Public Hearing if necessary. In
addition to the information required,the applicant may submit other supporting facts or documents which may assist
the Commission in its evaluation of this proposal.PLEASE SUBMIT NINE COPIES OF THE APPLICATION
AND NINE COPIES OF ANY OTHER DOCUMENTS AT LEAST FIVE BUSINESS DAYS PRIOR TO THE
MEETING.
I. Applicant Information
Name `14�y f fi���y ifc
Address (6q VeAlows '� DC' ie j CY/06V.i6
Tel# T-60 3i 'rfK-4 ) Cell# (.60 - 61r-S-5-3 UshL )
Fax# Email fckci(-_ . s'U�c {ye.t.lve,(6OA
Interest in Property VOwner ❑ Option Holder ❑ Developer ❑ Harvester ❑ Other
❑ Attach a Written Consent to the proposed activity from the owner if applicant is
not the owner ❑ Required ErNot Required
II. Owner Information
Name Address
Tel# Cell#
Fax# Email
M.Engineer Information Contact Se; ,L S.
Firm FAL 5�(veils 1-tc, Address C) 5'6 ).e,.))e--4 Ci f 6 P.11
Tel# 4Gv 7'7 G 33 Cell# gZ50 3cY i-13(J
Fax# Email P Sei+-Z Cr+i e-4i cos i-
IV.Attorney Information Contact
Firm Address
Tel# Cell#
Fax# Email
Levity__
Property Information
drss of Proposed ��q, ,�s 0 z r - G 71 c�
Assessor's Map and Lot Number_ fn,043 .61 -Lei-
Land Records/Deed Volume: 3 44 Page: ��3 4-4-Li Acreage of Property_ - 233 _
Zoning ( UO �� 3
Provide a List of the Names and Mailing Addresses of Adjacent Property Owners (Attach Sheet)
Inland Wetlands Application D
ETI
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VI.Wetlands and Watercourse Information
Total Acreage of Wetlands on the site acres
Wetland Disturbance Area CD sq ft
Upland Review Disturbance Area t t_to0 sq ft
Have the Wetlands Been Flagged qYes ❑No Year „Ip C}GL
Name of Soil Scientist rjo Q. 1-14-etwo s.
Linear Feet of Watercourse Disturbance 0 ft
Creation of New Wetlands C) sq ft
VII. rojectDescription
ubdivision C Review No Regulated Activity ❑ Permit Modification
C Regulated Activity C Permitted Use as of Right 0 Permit Renewal
Activity will involve(Check all that apply)
0 Alteration 'onstraction ❑Pollution 0 Stormwater Discharge
C Deposition of Material cubic yards
❑Removal of Material cubic yards
See attached checklist of items that are to be included on Plan and supplemental data.
A) Attach a Detailed Plan of the Proposal and indicate Plan Title and Date.
f` Z.e,— St.)ADA \3c.)A r ar P ,_pr-v U- Mere Or Oc,ca__ L
Vvvy- x- cc J5 .RA c�\� C�', Scq(e t '' (kj ir4'3
SUti\.e_ i'` - ' Act d 3 ,AA)'-e-r, $meq S j-s I i,>_4 3
B) Provide Brief Description of the Proposed Project on separate piece of paper.Instructions attached.
C) List Titles and dates of all documentation which will be included and submitted with this application
and attach to application. Documents should include, but are not limited to; Project Proposal, Soil
Scientist Reports, and Drainage Calculations. PRI05521- eck' '41 ase- �w�k� c„n 5 s -4-4't.na1
VIII. Other Information 3o-b` ;�� �► Q,N��s�� .(NA -uxiy c °C ct.4 44111.4,v-9
1. Does the application involve an activity in a regulated area that is within 500 ft of another
municipality? •
['Yes t ATo
-If YES, then a copy of the application and all material is to be submitted to said Town and a
copy of the transmittal fonu is to be provided to the Commission.
2. Is the property located within a Flood Hazard Area? ❑YeshTo
-If YES,then please provide additional material showing the location of the area.
3. Is the regulated activity within a Public Water Supply Aquifer or Watershed? ❑Yes A.No
-If YES,then a copy of the application and all material is to be submitted to the State Department
of Health as well as the appropriate Water Company. See attached instructions for the
Notification Process for the State Health Department. A copy of the transmittal forms shall be
provided to the Commission.
Inland Wetlands Application
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4. Does the application require approval from Uncas Health District? e.y es ON°
-If YES,then a copy of the approval is to be provided to the Commission.
5. Does the application require approval from the Public Works Dept? OYes 'To
-If YES,then a copy of the approval is to be provided to the Commission.
6. Does the application require approval from the Town of Montville WPCA? 0Yes No
-If YES,then a copy of the approval is to be provided to the Commission.
7. Does the application require permits from the following agencies?
Submission Info
Army Corps of Engineers 0Yes eo Date
Department of Environmental Protection 0Yes To Date
Department of Transportation 0Yes lAo Date
-If YES,then a copy of the application and all material is to be submitted to said Agency
and a copy of the transmittal form is to be provided to the Commission.
.8. Does this permit require a State Water Diversion Permit? DYes 'FKo
Vflo
'9. Does this permit require a State Dam Permit? 0 Yes
'10.Is this property subject to a Conservation Restriction and/or a Preservation Restriction?
-If YES,attach a copy of certified notice. 0Yes N1(o
11.If the application is a renewal or modification of an existing permit,is a copy of the original
approval included in the documentation package? ['Yes Neo
The undersigned applicant hereby consents to necessary and proper inspections of the above mentioned
property by agents of the Montville Inland Wetlands Commission at reasonable times, both before and
after the permit in question has been granted by the Commission.
Name Ae.4_41/ Date 13 PO 0
Property Owner if other than Applicant Date
Inland_Wetlands Application
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