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Application To Install Generators Or Buried Storage Tanks - Town Of New Canaan Department Of Environmental Health

Town of New Canaan

Non – Transferable

Approval Valid for One Year

Department of Environmental Health

77 Main Street, New Canaan, CT 06840

Fee - $50.00

Phone: (203) 594 – 3037 Fax: (203) 594 – 3125

Fee is Non-Refundable

Jen Eielson, Chief Sanitarian

Phone: 203-594-3019

Hours: 7:30 am-3:30 pm

PPLICATION TO

NSTALL

ENERATORS

URIED

TORAGE

ANKS

Location: _________________________________________________ Map: _______ Block: _______ Lot: ________

Owner: _______________________________________ Address: ___________________________________________

Installer: ______________________________________ Lic. #: __________________ Phone: __________________

Owner/applicant accepts full responsibility for the accuracy of the information and plot plan provided.

Owner/applicant also accepts the responsibility for the relocation of the proposed generator/buried

storage tank should it be necessary to repair/replace the well and/or septic system within the required

separating distance (see second page).

Provide a plot plan showing the proposed generator/buried storage tank. Show the existing well and septic system.

North Indicator

Any alterations or field adjustments MUST be submitted to Health and P&Z for approval prior to continuing the scope of work.

Applicant’s Signature: _________________________________________________

Date: _________________________________

Application Approved: _______________________ Denied: _______________________ Other: ______________________________

Sanitarian Signature: __________________________________________________________ Date: _______________________________

(P&Z requires survey – please see file)

Copy to P&Z: __________

Copy to Bldg: _________

rev. 6.3.15

Application To Install Generators Or Buried Storage Tanks - Town Of New Canaan Department Of Environmental Health