NOTIFICATION TO UNIVERSITY OF CONNECTICUT

NOTIFICATION TO UNIVERSITY OF CONNECTICUT

For Mansfield Projects within designated Aquifer Protection Areas
Section 8-3i of the State Statutes requires applicants to provide to all water companies written notice of an application, petition, request or plan if the proposed project is located within a designated aquifer protection area. The applicant must mail such notice within seven (7) days of the date of the application, by certified mail, return receipt requested. To meet this requirement, this form shall be used by applicants in Mansfield for projects within designated Aquifer Protection Areas in Mansfield. To determine if a project is within the aquifer protection area, please consult the Zoning Map. Failure of an applicant to comply with this statutory requirement may be grounds for a claim of procedural error ad a successful legal challenge of the decision rendered on the application.
Applicaon Submitted to: (Check one or more)

Inland Wetlands AgencyPlanning and Zoning CommissionZoning Board of Appeals
Type of Application:*

Zone ChangeSubdivisionVarianceSpecial Exception/PermitInland Wetland/Watercourses LicenseOther____________________
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Project Street Location/Nearest Utility Pole__________________________

Contact Person________________________________________________

Telephone number_____________________________________________

Brief description of application (For example: 10 lot subdivision of single family homes with on-site septic systems and wells)
Public Hearing Date:_____________ Commission/Agency Meeting Date(s)_________
Enclose a copy of the application submitted to the Town and a full set of project plans. Mail this completed form by certified mail, return receipt requested, to:

University of Connecticut, Facilities Operations and Building Services

Director of Utility Operations and Energy Management

25 LeDoyt Road, Unite 3252

Storrs, CT 06269-3252
Should be Empty: