HomeMy WebLinkAboutApplication Pleasant Valley Road/Clark S TOWN OF SOUTH WINDSOR
STAFF SITE CHANGE
FOR SITE & SUBDIVISION
GENERAL:
CHANGE ORDER CONTACT PERSON J�'s,✓1 /j f(�s��'�L�l Phone No. g(,0-- 6Y7- 79-Yq
Address _ ! //
Site Name -[? �,/> ��'oi 7: ► P&Z No.
Owner �) h 2/S P/' Phone No.-
Contractor C-007.
Signature of Owner Date:
Signature of Design Engr. Date:
CHANGE: (Describe location and nature of change. Include
Four (4) copies of plan/profile of Change. )
Add p01-
Reason for Change: (Why is change required)
PROVALS: (As Required)
Dir. Of Planningbw -jDate:
Town Engineer Date: -
Dir. of Public W rks Date:
Other: Date:
STAFF COMMENTS:
White - Town Engineer Yellow - Applicant
Pink - Director of Planning Goldenrod - Engineering Department
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TOWN OF SOUTH WINDSOR
STAFF SITE CHANGE
FOR SITE & SUBDIVISION
GENERAL: _
CHANGE O,f
j� DER CONTACT PERSON �C�y►1t� ►-t�c�viL�1 Phone No. ���
Ar e i
Address ® bi 425/ /e�:,(- / /3i Jwz// �U�f
Site 'N'ame � /1Q• f 74cc t / P&Z No.
Owner US��/� a`1/ke%S er e Phone No A(), s Lv, ?Z3 9
Contractor
Signature of Owner At Date: A IL
Signature of Design Engr Dater Z
CHANGE: (Describe location and nature of change. Include
Fou (4 ) copies of plan/profile of Change. )
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Reason for Change: (Why is change re uired)
`w Gr Pro v ode
APPROVALS: (As Rea
ire ) Jc3/
At Dir.. Of Planning Date: Z J Z
Town Engineer Date:
Dir. of Public Works Date:
Other: Date:
STAFF COMMENTS:
White - Town Engineer Yellow - Applicant
Pink - Director of Planning Goldenrod - Engineering Department
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