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Home My WebLink AboutApplication \\planning\planningoffice$\APPS, Forms, Templates\APPs & Guidelines (Each) rev 11-16-2018\IWC APP rev 8-24-2020.doc 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 FOURTEEN (14) COPIES OF THE APPLICATION AND FOURTEEN (14) COPIES OF ANY OTHER DOCUMENTS AT LEAST FIVE BUSINESS DAYS PRIOR TO THE MEETING. I. Applicant Information Name________________________________ Address__________________________________________ Tel #_________________________________Cell #____________________________________ Fax #__________________________Email___________________________________________ 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 Page 1 of 3 \\planning\planningoffice$\APPS, Forms, Templates\APPs & Guidelines (Each) rev 11-16-2018\IWC APP rev 8-24-2020.doc VI. Wetlands and Watercourse Information Total Acreage of Wetlands on the site____________________ acres Wetland Disturbance Area_____________________________ sq ft Upland Review Disturbance Area ________________________sq ft Name of Soil Scientist____________________________________ Linear Feet of Watercourse Disturbance_____________________ ft Creation of New Wetlands________________________________ sq ft VII. Project Description Activity will involve (Check all that apply) 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 ft 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 located within a Flood Hazard Area? -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. Inland Wetlands Application Page 2 of 3 \\planning\planningoffice$\APPS, Forms, Templates\APPs & Guidelines (Each) rev 11-16-2018\IWC APP rev 8-24-2020.doc 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. 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 Page 3 of 3 Town of Montville Inland Wetlands Application Beechwood Road Culvert Replacement Parcel Number GIS Number Cama Number Property Address Owner Name Co-Owner Name Owner Address Owner Address 2 Owner City Owner State Owner Zip 081-050-000 081-050-000 081-050-000 62 BEECHWOOD ROAD MCCARTHY THOMAS L 62 BEECHWOOD ROAD OAKDALE CT 6370 081-051-000 081-051-000 081-051-000 66 BEECHWOOD RD ZIZIK JOSEPH M & ROBERTA 66 BEECHWOOD RD OAKDALE CT 06370 081-019-000 081-019-000 081-019-000 WOODCHUCK RD OAKDALE HEIGHTS ASSOC INC PO BOX 144 OAKDALE CT 063700144 081-020-000 081-020-000 081-020-000 59 LAUREL DR BROWN JENNIFER L 59 LAUREL DR OAKDALE CT 06370 081-021-000 081-021-000 081-021-000 55 LAUREL DR STEVENS BROOKE D 55 LAUREL DR OAKDALE CT 063701727 081-049-000 081-049-000 081-049-000 58 BEECHWOOD RD RUSS MATTHEW R 58 BEECHWOOD RD OAKDALE CT 06370 081-052-000 081-052-000 081-052-000 70 BEECHWOOD RD BARNES PAUL DAVID 70 BEECHWOOD RD OAKDALE CT 06370 081-067-000 081-067-000 081-067-000 67 BEECHWOOD RD GLYNN EDMUND & FRANCES R 67 BEECHWOOD RD OAKDALE CT 06370 081-068-000 081-068-000 081-068-000 63 BEECHWOOD RD ROTHHOLZ MICHAEL FRANCIS & REBECCA LYNN 63 BEECHWOOD RD OAKDALE CT 06370 081-069-000 081-069-000 081-069-000 59 BEECHWOOD RD SHEFLOTT PATRICIA P 59 BEECHWOOD RD OAKDALE CT 063700279 081-070-000 081-070-000 081-070-000 55 BEECHWOOD RD MURPHY MICHAEL J & DEBRA K 55 BEECHWOOD RD OAKDALE CT 06370 PROPERTY OWNERS PROPERTY ABUTTERS