HomeMy WebLinkAboutChange Order Plasma Technologies r
TOWN OF SOUTH WINDSOR
STAFF SITE CHANGE
FOR SITE & SUBDIVISION
GENERAL:
CHANGE ORDER CONTACT PERSON . JA m E.5 A�j q Phone No. 8 60, 0-7. -J 5 y Li
SM Address CrcN u1 Me K0 tj Uf#
Site Name p �� M �,��� P&Z No.
Owner Q T Z 1 me eS t me AJ LL LL L Phone No.lko- 11 S2-0(059
Contractor R 16rl �,
Signature of Owner �n Z) ,mil {�j' Date: -(o-ZOl 0
Signature of Design Engr. jC-1ra3 {- kiff"t Date: - - 201(.
CHANGE: (Describe location and nature of change. Include
Four (4) copies of plan/profile of Changer.')
L...bAstr�.c �' 0C.w ��14C �Qnec� ; ' X
Reason for Change: (Why is change required)
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APPROVALS: (As Required)
Dir. Of Planning Date:
Town Engineer Date:
Dir. of Public Works Date:
Other: Date:
STAFF COMMENTS:
RECEIVtU
INDSOR PLANNING DEPT.
White - Town Engineer Yellow - Applicant
Pink - Director of Planning Goldenrod - Engineering Department
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