HomeMy WebLinkAboutChange Order for Scoreboard TOWN OF SOUTH WINDSOR
STAFF SITE CHANGE
FOR SITE & SUBDIVISION
GENERAL:
CHANGE ORDER CONTACT PERSO,&&a% � Phone No.T60• Zal! I ZL4
AddressNPv��'r &a d
Site Name . t�vt�rar.�a v- 07 n•a e�s..cxa-: +raa •OW• - -
Owner_ a-c1Nr c Se u�, Ls.>i av id✓' Phone No. •Z Q�- /ZZO
Contractor NorC�ew✓ � !l
Signature of Owner Date: !2. • /Y'/G
Signature of Design Engr. Date:_
CHANGE: (Describe location and nature of change. Include
Four (4) copies of plan/profile of Change. )
- In
Reason for Change: (Why is change required)
zg ke tJ ,t. k C -s erLl t H.
_..,•e M Ceycty: L- �10 J'Nc�te�itt=
APPROVALS: (As Required)
Dir.. Of Planning ' as Date: =--
Town Engineer - Date:
Dir. of Public Works Date:
Other: Dates
STAFF COMMENTS:
i
White - Town Engineer Yellow - Applicant
Pink - Director of Planning Goldenrod - Engineering Department