Fillable REGULATED ACTIVITY CITY OF DANBURY APPLICATION FOR PERMIT (City of Danbury)

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REGULATED ACTIVITY CITY OF DANBURY APPLICATION FOR PERMIT (City of Danbury)

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The REGULATED ACTIVITY CITY OF DANBURY APPLICATION FOR PERMIT (City of Danbury) form is 3 pages long and contains:

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Rev February 4, 2011 Page 1 of 4
CITY OF DANBURY
155 DEER HILL AVENUE
DANBURY, CONNECTICUT 06810
ENVIRONMENTAL IMPACT COMMISSION
(203) 797-4525
APPLICATION FOR PERMIT TO CONDUCT
REGULATED ACTIVITY
FOR COMMISSION USE ONLY:
Filing Fee: Filing Date:
Date of Regular Meeting for Consideration:
APPROVED:
DENIED:
***NOTICE***
Please refer to the Inland Wetlands and Watercourses Regulations of the City of Danbury (the
“Regulations”) for all requirements for submission of applications.
1. LOCATION AT WHICH ACTIVITY IS PROPOSED:
Address: Assessor's Lot No.:
Descriptive location – attach map if necessary:
Property is located on the (north) (south) (east) (west) side of the above street, and distant approximately
feet (north) (south) (east) (west) from (nearest intersection).
2. APPLICANT:
Name:
Address:
City: State: Zip:
Telephone:
Reset Form
Rev February 4, 2011 Page 2 of 4
3. PROPERTY OWNERSHIP:
a. Applicant's interest in property (check one):
Owner Developer Option Holder Other (describe)
b. If applicant is not owner, give name, address and daytime number of owner(s):
Name: Telephone:
Address: City: State: Zip:
4. AGENT (if applicable):
Name: Title:
Address: City: State: Zip:
Telephone:
5. INTENDED USE OF PROPERTY:
6. TOTAL AMOUNT OF AFFECTED WETLANDS OR WATERCOURSES:
Wetlands: square feet Watercourses linear feet
7. DOCUMENTS: (Submit 14 copies of each document)
List the titles of site plans, drawings, cross sections with the latest revision dates, and any reports
that are part of the application and are accompanying this form:
8. DOES THE PROPOSED ACTIVITY REQUIRE:
Subdivision re resubdivision approval
Special Permit from Zoning Commission
Special Exception from Planning Commission
Variance from the Zoning Board of Appeals
Site Plan approval by Planning Department
Zoning Permit
Rev February 4, 2011 Page 3 of 4
9. CHECK WHETHER ANY OF THE FOLLOWING CIRCUMSTANCES APPLY:
Any portion of the wetlands or watercourses for which the regulated activity is proposed is
located within five hundred (500) feet of the boundary of an adjoining municipality (see
Section 7.13 of Regulations).
Any portion of the property affected by the decision of the commission is located within five
hundred (500) feet of the boundary of an adjoining municipality (see Section 7.14 of
Regulations).
A significant portion of the traffic to the completed project on the site will use streets within
the adjoining municipality to enter or exit the site (see Section 7.14 of Regulations)
A significant portion of the sewer or water drainage from the project site will flow through
and significantly impact the sewage or drainage system within the adjoining municipality (see
Section 7.14 of Regulations).
Water run-off from the improved site will impact streets or other municipal or private
property within the adjoining municipality (see Section 7.14 of Regulations)
Any portion of the wetland or watercourse on w hich the regulated activity is proposed is
within the watershed of a water company (see Section 7.15 of Regulations).
10. DOCUMENTS (to be submitted for complete application):
Completed and signed “Application for Permit to Conduct Regulated Activity”
Eight copies of site plans, drawings, cross sections, and reports:
Site plans must show existing and proposed conditions in relation to wetlands and
watercourses, including soil types, vegetation and existing and proposed improvements.
Eight Copies of Narrative Description of Proposed Activity:
Describe the proposed activity, its purpose and intended use, area of wetlands to be altered,
mount and type of materials to be removed or deposited, structures and construction
activities, the manner in which the work will be carried out, anticipated time of construction,
and the relationship of proposed work to existing facilities, projects, or activities.
Eight Copies of Narrative Description of Alternatives:
Describe alternatives considered and why the proposal set forth in the application was chosen
List of names and mailing addresses of all owners of Property abutting or across the street
from the subject property.
Payment of all required fees for review. Refer to Fee Schedule in Sec. 12 of the
“Regulations”. Checks to be payable to the City of Danbury (amount to include $60.00 State
Land Use Application Fee as required per C.G.S.).
Print Form
Rev February 4, 2011 Page 4 of 4
11. ADDITIONAL INFORMATION:
The Commission may require additional information from the applicant pursuant to Sections 7.4
and 7.7 of the Regulations
12. OWNER’S CONSENT TO INSPECTIONS OF PROPERTY
The undersigned, as owner of the property, hereby consents to necessary and proper inspections
of the above-mentioned property by a gents of the Environmental Impact Commission of the City of
Danbury, at reasonable times, both before and after a final decision has been issued by the Commission.
Signature of Owner Date
13. APPLICANT'S CERTIFICATION TO SUBMITTED INFORMATION
The undersigned hereby certifies that the information provided in this application including its supporting
documentation is true and correct, and is aware of the penalties for obtaining a permit through deception
or through inaccurate or misleading information.
Signature of Applicant Date
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REGULATED ACTIVITY CITY OF DANBURY APPLICATION FOR PERMIT (City of Danbury)

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Completed 9 February 2021

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