HomeMy WebLinkAboutSWP273245 PROJECT REQUEST FORM
PLANNING/BUILDING/PUBLIC WORKS
DATE: 2 p CONTACT: /t'f// �1�v, EXT.
FILE STATUS NEW OR ❑ EXISTING: FILE CODE(PRl-xx-xxxx):
LOCATION N My Work Space: 0 File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE:
(70 characters max)
DESCRIPTION OF PROJECT: �^ 7J
L4� n/1 J � � 0/✓�Gry.J��►'Leil� T� Si bG�l4��LP o>r
UTILITY PERmrr# S C LUA# l� WO#
ADDRESS/STREET NAME(S): o 72. /--tv Al
DEV: CNTR: ;OWN: &,,s S ; CNSLT/ENG:
OTHER ALIASES:
Circle Size of Waterline: 4'' 8" 10" 12" Circle One: N w/Replace/Extension
Circle Size of Sewerline: 8" 10" 12" Circle One: New/Replace/Extension
Circle Size of Stormline: 18" 24" Circle One /Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
TED ❑ d�
(off site improvements) (include TESC)
❑ TRO ❑ ❑
(Signalization,Channelization,Lighting)
� w ❑ 1
(sanitary sewer main,include basin name)
WTR ❑ I
(Mains,Valves,Hydrants) (inc.composite&HodzonWCtrl)
❑ 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 FH E MAINTAINANCE USE ONLY
File Codes File Alias Date Entered and Labels Made N
0- 45 ,,// -
3 Y'
T ;R -3'
a
s 14 " I 7r