Application for Modification to Approved Site Plan and/or Special Use Permit

Application for Modification to Approved Site Plan and/or Special Use Permit
Additional information regarding revisions to approved site plans and special permits can be found in § 190-74I of the Mansfield Zoning Regulations. The Commission has the authority to approve revisions without the submission of a new site plan or special permit application. Where the proposed revision is considered a significant alteration of the existing plans, the Commission may require the submission and processing of a new site plan or special permit application.
- Before starting this application, please be sure you have the required information and documents ready.
- Make sure that required documents are saved in PDF form and appropriately named. For example: "Approved Plan," "Proposed Modification," etc.
- Please call the Department of Planning and Development at 860.429.3330 with any questions on how to complete the form.
Who is completing this application form?*

ApplicantAgent for the Applicant
Applicant Information
Is the applicant the property owner?*

YesNo
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Applicant Interest in Property*

LesseeOptioneeOther

Property Owner Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Agent Information
Have any agents been authorized to represent the applicant regarding this application?*

YesNo
Please attach contact information (name, company name, address, phone and email) for each person that may be directly contacted regarding the application.
Agent Contact Information

Cancelof
What is this agent's role on the project team?*

ArchitectAttorneyEngineerLandscape ArchitectSurveyorOther
Other**

Aquifer Protection Area Notification
To determine if your project is in the designated Aquifer Protection Areas, please view the Zoning Group Layer of the Town's GIS Map at https://www.axisgis.com/mansfieldct/
Is the subject property located within a designated Aquifer Protection Area?*

YesNo
Applicants for projects located within a designated Aquifer Protection Area are required to notify the University of Connecticut via certified mail and the Department of Public Health through the completion and submission of the CTDPH Watershed or Aquifer Protection Area Notification Form. These notices shall be sent within (7) days of the Commission’s receipt of the application and documentation of such notice shall be provided to the Department of Planning and Development. A notification form for the University of Connecticut is available at https://www.mansfieldct.gov/DocumentCenter/View/2605/Notification-to-UConn-for-Aquifor-Protection-Areas-for-Mansfield-Projects.
Willimantic Reservoir Watershed Notification
The Willimantic Reservoir Public Drinking Water Supply Watershed encompasses much of the eastern half of Mansfield. To determine if your project is located within the Willimantic Reservoir Public Drinking Supply Watershed, please review the map located at https://www.mansfieldct.gov/DocumentCenter/View/4647/Will-Reservoir-Watershed.
Is your project located within the Willimantic Reservoir Public Water Supply Watershed?*

YesNo
Applicants for projects located within the watershed of the Willimantic Reservoir are required to notify Windham Water Works via certified mail and the Department of Public Health through the completion and submission of the CTDPH Watershed or Aquifer Protection Area Notification Form. These notices shall be sent within (7) days of the Commission’s receipt of the application and documentation of such notice shall be provided to the Department of Planning and Development. A notification form for Windham Water Works is available at https://www.mansfieldct.gov/DocumentCenter/View/2606/Notification-to-Windham-Water-Works-for-Mansfield-Projects---Fillable-PDF.

Application Fee
A non-refundable application fee is required pursuant to Section 122-2 of the Mansfield Code of Ordinances.

Earlier in this application, you were asked a series of questions regarding the nature of the proposed revision in an attempt to identify whether Commission approval would be required. If you answered "No" to all of those questions, it is presumed the request is of a minor nature that can be reviewed and approved by the Zoning Agent and Chair of the Planning and Zoning Commission. If it is determined through the review process that Commission approval is needed, you will need to pay the balance of the fee required for a Commission review.
Application Fee Due

$250.00
Fee Payment Options
Application fees are accepted as follows.
- Check. A check payable to the Town of Mansfield can be paid in person at the Department of Planning and Development; left in the drop box at the eastern entrance to Town Hall in an envelope addressed to the Department of Planning and Development; or mailed to: Department of Planning and Development, 4 South Eagleville Road, Mansfield, CT 06268-2599
- Credit Card. Credit card payments are accepted in person in the Department of Planning and Development or over the telephone at 860.429.3330 during regular business hours.
- Cash. Cash in the amount due can be paid in person at the Department of Planning and Development.
Applicant Certification Statement

In signing and submitting this application, I hereby certify the following:
- I will send the required notices (if applicable) to the Department of Public Health and applicable water company/water supply system within 7 days of Commission receipt of the application and provide documentation of said notice to the Department of Planning and Development prior to issuance of a decision.
- I am familiar with the information contained in the application submissions and that such information is complete, true and correct to the best of my knowledge.
- I understand the penalties for obtaining a permit through deception or through inaccurate or misleading information.
- I understand that the subject application must comply with all applicable requirements of the Mansfield Zoning Regulations.
- I understand that the subject application will not be considered completed until the Property Owner of record completes and submits the Property Owner Certification Statement, available at https://mansfieldct.jotform.com/221805474458865.
Signature*

Clear
Zoning Agent Signature
Signature

Clear
PZC Chair Signature
Signature

Clear
Date*
Should be Empty:

Application for Modification to Approved Site Plan and/or Special Use Permit

Applicant Information

Property Owner Information

Agent Information

Property and Project Information

Historic and Cultural Features

Proposed Revision

Aquifer Protection Area Notification

Willimantic Reservoir Watershed Notification

Application Fee

Application Fee Due

Fee Payment Options

Applicant Certification Statement

Zoning Agent Signature

PZC Chair Signature