Inland Wetlands Commission	File:#	   - 0

Town of Prospect, CT

______Application for Inland Wetlands Permit______

* Fee Schedule: 25.00 plus .................... 25.00

	15.00 per acre (Total Parcel):		_______X  15.00 = ...........

	100.00 per Regulated Activity:		_______X 100.00 = ...........

	(Per Regulations Section 2 "Definitions")

	Public Hearing Charge (if applicable):			    	150.00

						Total: ................

	(Please make check payable to: Town of Prospect)

* An additional State of Connecticut fee is collected also at this time:

*** State of Connecticut P.A. 92-235 .............................................10.00

* Submit Six (6) copies of this completed application with appropriate fee.

________________________________________________________________________________________________

Dated: ..............................

Name of Property Owner: ......................................................

Home Address: .......................................................................

Business Address: ....................................................................

Home Phone: ............................. Business Phone: ...................
Name of Applicant: .................................. ( ) Owner ( ) Agent

Home Address: ......................................................................

Business Address: ..................................................................

Home Phone: ............................. Business phone....................
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	Check if other than owner: .............
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*if the above is checked, written consent of the property owner, duly notarized, to the proposed activity as set forth in the
application is required.
Location of Property (Road): ...............................................................

Assessor's Plate No. ...................................... Lot No. .......................

Land Record Volume No. ................................. Page No. ...................
Describe the proposed activity. List all the proposed activities that you are applying for.

(Per Section 2.11 and Section 5.2E of the Inland Wetlands Regulations of the Town of Prospect.
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Plan for Plantings and Stabilization. Specify timetable for project.

(Per Section 5.2 F of the Inland Wetlands for the Town of Prospect.)

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Include a map of the property with a detailed drawing showing the extent of the proposed activities. The map must be signed and dated.
Is this application part of a previously filed application?
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				Yes ...... No ......
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Is this application the first part of other applications to be filed with this commission?
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				Yes ...... No ......
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Has there been an application filed on this property during the past five (5) years?
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				Yes ...... No ......
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Is a special permit exception required?
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				Yes ...... No ......
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(If so, the applicant must submit evidence of compliance with Section 11.3 of the Inland Wetlands Regulations of the Town of Prospect.)
Does this application involve a regulated activity upon an inland wetland or watercourse of the Town, or any portion of which is within five hundred feet of the boundary of another municipality?
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				Yes ...... No ......
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If any regulated activity is in a watershed area of a water company, proof of compliance with Section 22a - 42f of Connecticut General Statutes, Chapter 440 - "Notice to water company certified mail, return receipt requested and mailed within seven (7) days of the application."
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				Yes ...... No ......
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Is the regulated activity within a proposed aquifer protection area?
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				Yes ...... No ......
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Is the regulated activity in or will it affect a Flood Hazard Area?
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				Yes ...... No ......
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The applicant understands this application is considered complete only when all information and documents required by the Commission have been submitted.

* * * * * * Agreement * * * * * *

The applicant agrees to inform the Inland Wetlands Officer 72 hours before commencing regulated activities:

Signed: ........................................................................................... Dated: .............................................

The applicant hereby consents to inspection of the site of the proposed activity at any reasonable time before or after the granting of a permit in accordance with Section 12.1 of the Inland Wetlands Regulations of the Town of Prospect.

The undersigned warrants the truth of all statements contained herein and all supporting documents according to the best knowledge and belief.

Applicant's Signature: .................................................................... Dated: .............................................

Authorized Agent's Signature: ........................................................ Dated: ..............................................

* * * * * * * *

This form received by the Commission on:

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* * * * * * * *

Application Fees in the Amount of $ ............................. received by the Commission:

		................................... Dated: ......................

Supporting Documents completed:

		................................... Dated: ......................

Commission Decision:*

Decision Dated: ............... Approved:* ............... Denied: ...............

Approved Based on Map Dated: ............... Revision Dated: ...............

Modifications and Stipulations:*

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*Reference Inland Wetlands approved minutes for details of action taken.