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HomeMy WebLinkAboutApplication Files_85051_pg0148 TOWN OF SOUTH WINDSOR STAFF SITE CHANGE FOR SITE & ISUBOXVISION GENERAL: CHANGE ORDER CONTACT PERSONA � Z-0 � �j Z.0 /, t�."�•_ � Phone No. 1 Addre s i✓L1rf! t7" 1��t1Cf -91??Cfk lr C? • Ofi�D3'w Site Name 1�+2E. r it -DIN P&Z No. - _ Owner Q0.1?-N L�J�ti sat Epl r� I Q FFIC 6 gu i o m, hone No. 8,0. �10-,,I, ©Q ga Contractor! ,#1. �. Signature of Owner Date: Signature of -Design Endr-IdAIWDate:=`z ( .. CHANGE: (Describe location and nature; of change. Include Four (4) copies of plan/profile` of Change. ) L,ti�i4} A%t L ri or 140,PJZ3% C Pl 2AVY1 of &P niyt2-4\ 5 A-s r Reason for Change: (Why is change required) �L"�Y��►rJA-rj�•! ►mot ����y��,1ZG1yE �, �tPt t ra 1�-1 �-�� � n> Tt�C r4�t�-� �:� Z�ayL,r-- p r i),rs-•-Tit dt,., c CIA FL I c_Ta A 1-1 nra c}v� 12�y "W3 APPROVALS: (As Req 'red) t Dir.. Of Planning ``J Date: G f.2111 Z Town Engineer J . ti-i—( '� bf L. ,.----- Date:. 6 Dir. of Public Works Date: Other: Date: STAFF COMMENTS: White - Town Engineer Yellow - Applicant Pink - Director of Planning Goldenrod - Engineering Department