Conservation Commission Agenda (linked)

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TOWN OF WATERFORD | MAR 2 6 2024
Application for Inland Wetland / Watercourse Permit
Planning & Developmer
| ssi of Waterford, CT |
Type of Application: Agency Use:
Permitted Use, Section 4.1 . Date Received:
Unregulated Activities, Section 4.2 Received By:
Regulated Activities, Section 6 Fee: t/ [6.00 Application Number: __ C- A4/-0]
1. Applicant: Benyamy Ny Topkia Phone: $60 -3 26 ~Y6SO
Address: /Z\ LAKE SIDE DZ LENYAGS State: CT Zip: O6 33 q
Fax: E-Mail: B TopkcnN MACL ,CoOM
2. Owner: Beata min Tepk in Phone: 560 ~322 -Y¥650
Address: IZ CAKESTOE DA LED YARNS State CT Zip: OC839
Fax: E-Mail: BTOPKaInN ~Aol.com
3. Agent: Phone:
Address: State: Zip:
Fax: E-Mail:
4. Property Address: 76 DAYTON) (2D ivATER FORD rae T S55
5. Abutting Property Owners — Complete Attached Form
6. Activity to be Reviewed and / or Licensed (attach sheet if necessary):
CONSTRUCTION of A NEW Home wrryt A Dacve way
IN THE foot vuPpLAnd REVTeEW AGA
7. Description of Proposed Activity (attach sheet if necessary):
Shane As Above
8. Purpose of Activity (attach sheet if necessary): _.S, AAG A s Agove
9a. Acreage of Property: | 3 2 / 6 9b. Acreage of Wetlands: Zis
10. Acreage of Wetlands Altered: ZA
11. Wetland Mitigation Proposed: IZA ;
12. Section 7 and sections 8.1 & 8.2 of the Town of Waterford “Inland Wetlands and Watercourse Regulations”
have been complied with: (Review attached check list) Yes: No:
The applicant / owner hereby gives the Commission, its agent and consultants the right of free access to any
part of the property under consideration. The undersigned warrants the truth of all statements contained
herein and in all supporting documents according to the best of his / her knowledge, information and belief.
Applicant: Co off Date: 3~ZO-Z2Y
Owner: Z Zip— Date: Z- Z5 ~ 2G
Agent: : ; Date:
IWW Permit Application form.docx
‘Updated 3 2011

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