HomeMy WebLinkAboutPermit Wastewater Allocation WWA-12-03------
p.1
, Jan 181205:00p Bob Cooper 2396426739
FORINTERN..4..L USE ONLY
Permit #~.....,;;;....:--.
CITY OF SO H B GTON
PLICATION for WASTEWATER ALLOCATION
*Itemsmarked'\vith an asterisk mustbefilled in byALLapplicants
itAPPLICANT INFORMATION
Ap:plicant~ J. Graham Goldsmith Architects
Contact Person: Adam Davis
Mailing Address: 7 .Kilburn Street, Burlington, vr 05401
Telepbone & Fax forContact Person:.~8o~2=..-~8~6=.2-"l:I4~O~53.::L-__~~__~~~__
PropertyO",ner Name (ifnot applicant): _R~ob~e~rt.!<..Q~o~Q~p~e~r__~_.....,....,..,.,.-;-__....,....
Property OVIr'ller Mailing Address: lz61\1:anner's Cove. Shelburne, VT QS482
*Projecl:Information
Ifthe project isa single,..family home;! please check one: ---.2LNew __' _.,ExiSting
Ifnota single-family home, project name: _____~___...---,--___
'*App1ication or PermitNumbers: (from Planning & Zoning office)
#-.-.------
Enginee~s Information for flows over 1,000gpdNameofEngineer:_..;..,-__________________~
Finn: ____~~__________--__----------------------------------Mailing ____________________--.-...-....-..'Uo...............,u.
Phone&Fax: ______________~________
FE License #: ___________....,--.-...,.--.,-_~_.,___..,...._,...__,_,...~--,
*Flow Calculations
(You may substitute an engineer's calculation or letterfor the information requested
below)
Forresl-dential prQ.lects, r1St number 0 fbedroomsand unIts requeste d:
Number of
Bedrooms
Number ofUnits
X
Gallons per day
per unit =
Total Flows
1 140
2 or more 1 210 210
TOTAL
Notes: _______________________________________________________
For commercial and industrial projects, list existing and proposed tenants, uses and
flows:
Tenant/ Type ofuse Number of Flows per Other Total
Business seats, SF, etc X unit Adjustments Flow
TOTAL
*Total development wastewater flow requested: 210 gallons per day
Flow characteristics (for commercial and industrial projects)
Volume:
Flow rate:
Strength:
Please do notwrite below this line
Application & Recording Fee received: \?(AD \ CO/..?/.Jer ]Irt:t!zol ~
Name Date
Receiving Plant: . Airport Pkwy _---:v,e;-,Bartlett Bay
City Center District: __Yes \I No
Approved by Water Pollution Control Department (Commercial and Industrial
Projects)
Director ofWater Pollution Control Date
Preliminary allocation issued: (payment offee is not required) /?/~ ../#f~. Ifl9holz
Dtrector of Planning and Zoning Date I
Final allocation issued: (payment offee is required, either injull or pro-ratedfor
projects with mUltiple zoning permits involved)
Director of Planning and Zoning Date
Final allocation expires _________with permit # __-__-__
(Date)
Zoning permit issued. __________with permit# __-__-__
(Date)
Associated WW connection permit (if applicable)
For extensions ofFinal Allocation Only
EXTENSION GRANTED
(Date) (Date of Expiration)
50% EXTENSION FEE PAID
(Date) (Amount)