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Town of Montville Inland Wetlands Application Permit# ___________________Check #_________
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 (9) COPIES OF THE
APPLICATION AND NINE (9) COPIES OF ANY OTHER DOCUMENTS AT LEAST FIVE (5) BUSINESS DAYS
PRIOR TO THE MEETING.
I. Applicant Information
Name Address
Tel # Cell #
Fax # Email
wner
Attach a Written Consent to the proposed activity from the owner if applicant is
not the owner
II. Owner Information
Name Address
Tel # Cell #
Fax # Email
III. Engineer Information
Contact
Firm Address
Tel # Cell #
Fax # Email
IV. Attorney Information
Contact
Firm Address
Tel # Cell #
Fax # Email
V. Property Information
Address of Proposed Activity
Assessor’s Map and Lot Number
Land Records /Deed Volume: Page: Acreage of Property
Zoning:
Provide a List of the Names and Mailing Addresses of Adjacent Property Owners (Attach Sheet)
Inland Wetlands Application
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Tyler Lawton 10 Carolina Dr Apt 20
860-941-3979 860-941-3979
tylerlawton06@gmail.com
0158 0828 17.16
083-029-000
GOV
911 Norwich-New London Tpke, Uncasville, CT 06382
310 Norwich-New London Tpke, Uncasville, CT 06382Town of Montville
860-848-3030
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VI. Wetlands and Watercourse Information
Total Acreage of Wetlands on the site____________________ acres
Wetland Disturbance Area_____________________________ sqft
Upland Review Disturbance Area _______________________ sqft
Have the Wetlan
Name of Soil Scientist____________________________________
Linear Feet of Watercourse Disturbance_____________________ foot
Creation of New Wetlands________________________________ sqft
VII. Project Description
Activity will involve (Check all that apply)
rge
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.
__________________________________________________________________________________________
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.
VIII. Other Information
1. Does the application involve an activity in a regulated area that is within 500 feet of another
municipality?
- If YES, then a copy of the application and all material is to be submitted to said Town
and a copy of the transmittal form is to be provided to the Commission.
2. Is the property l
-If YES, then please provide additional material showing the location of the area.
3.
- 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.
4. Does the application require approval from Uncas Health District?
- If YES, then a copy of the approval is to be provided to the Commission.
Inland Wetlands Application
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2021
Robert Russo
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5. Does the application require approval from the Public Works Dept?
- 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?
- 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 Date ___________
Department of Environmental Protection
Department of Transportation ____
- 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?
9. Does this permit require a State Dam Permit?
10. Is this property subject to a Conservation Restriction and/or a Preservation Restriction?
-If YES, attach a copy of certified notice.
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?
______________________________________________________________________________
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__________________________________________ Date______________________
Property Owner if other than Applicant________________________________ Date___________
Inland Wetlands Application
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