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HomeMy WebLinkAboutSWP273231 PROJECT REQUEST FORM PLANNINGBUILDING/PUBLIC WORKS DATE: -.2 6-C) CONTACT.- J-UL4 IITJ/- EXT. FTLE STATUS ANEW OR ❑ EXISTING: FILE CODE(PRl-Xx-xxxx): LOCATION ❑ My Work Space: ❑ File Bay Shelf#: ❑ Other: PROJECT NAME/FILE TITLE: Jt_:�R\C PAT- (70 characters max) DESCRIPTION OF PROJECT: 3� -LAC Puy i 01 MEW HA-IN C-XT&�©Al I - —TNT .. UTILITY PERMIT# UO y d A 9 0 LUA# ®0-O 81 WO# ADDRESS/STREET NAME(S): � DEV:CeT001P,A0'Q ; CNTR: ;OWN:'�1( ►�OHf �NSLT/ENG�II-f y OTHER ALIASES: Circle Size of Waterline: 8" 10" 12" Circle One: New/Replace/Extension Circle Size of Sewerline: 10" 12" Circle One: e /Replace/Extension Circle Size of Stormline: 12" 18" 24" Circle One New Replace/Extension CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets TED ❑ ❑ (off site improvements) (include TESC) R�- TRO ❑ ❑ (Signalization,Channelization,Lighting) WWP 0 ❑ (sanitary sewer main,include basin name) ❑ WTR ❑ ❑ (Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl) ❑ SWP ❑ ❑ (CIP onlyxinclude basin name) ❑ PLR (For Developer Files Only) ❑ (letter only) PLEASE CIRCLE THE DISCIPLINES WHICH NEED TO SIGN MYLARS WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE FOR FILE MAINTAINANCE USE ONLY File Codes File Alias Date Entered and Labels Made -3a 6 -3 g W s..Et e Olaf'-" f