HomeMy WebLinkAboutStaff Site Change TOWN OF SOUTH WINDSOR
STAFF SITE CHANGE
FOR SITE & SUBDIVISION ^ '
GENERAL:
CHANGE ORDER CONTACT PERSON Dtcy:�1 2ya11 Phone No. G y y 56 u Z
Address Z1(0 y tp,/1 /%,,,d Di-vve, so"-/; Lv1A10'S'b,C
'�P,Site Name lsyv%o, w, rm,-, ,e �,..�o,,.,.,,1�,v..vv` P&Z No.
Owner ��rc�w a3 h �, �s2 o e,�o'1'�va. , 5-..c Phone No.
Contractor �z�ir6Prr..r c,c f,aN
Signature of Owner Date:
Signature of Design Engr. Date: kIA *'�?-ooc.3
CHANGE: (Describe location and nature o • change. Include
Four (4 ) copies of plan/profile of Change. )
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Reason for Change: (Why is change required)
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APPROVALS: (As Require )
Dir. Of Plannin - Date: L(-3Q dO
Town Engineer Date: //-30.-cc)
Dir. of Publi ork Date:
Other: Date:
STAFF COMMENTS:
White - Town Engineer Yellow - Applicant
Pink - Director of Planning Goldenrod - Engineering Department