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HomeMy WebLinkAboutSWP273273 PROJECT REQUEST FORM PLANNING/BUILDING/PUBLIC WORKS DATE: C CONTACT: v FILE STATUS NEW OR ❑ EXISTING: FILE CODE PRl-xx-xxxx): LOCATION ❑ My Work Space: 0 File Bay Shelf#: 0 Other: ROJECT NAME/FILE TITLE: ?AZk,"-LAj\A4e' C.0 0, (70 characters max) ESCRIPTION OF PROJECT: \O—ucry- IPL -V- W k-"A CSy sTf�M , 4�eTe'h'MO N / QQ A L 1*-V SQL\Cam-pets C-0 5 1 or4 L`IONs "3VJF 1N� UTILITY PERMIT# y 0-S-C) ( © LUA# q - I L4 -Z WO# ADDRESS/STREET NAME(S): DEV: Rif K-N FI CNTR: ; OWN: ; CNSLT/ENG: bA I(--'I AA 4" OTHER ALIASES: Circle Size of Waterline: 8" 10" 12" Circle One: New/Replace/Extension Circle Size of Sewerline: 10" 12" Circle One: Replace/Extension Circle Size of Stormline: 12" 18" 24" Circle One fe7 Replace/Extension CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets � TED ❑ ❑ (off site improvements) (include TESC) TRO El El(Signalization,Channelization,Lighting) W WP ❑ ❑ (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 f-: -TO-3 -4f-3;Z73