HomeMy WebLinkAboutSWP273282 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
FILE STATUS W OR ❑ EXISTING: FILE CODE(PRI-xx-xxxx):
LOCATION My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE: 7 u M IZ�A S1-�2Z- CA
(70 characters max)
DESCRIPTION OF PROJECT:
UTILITY PERMIT# ti OS S LUA# o S——�6 7 WO#
ADDRESS/STREET NAME(S): &Yk, 5 '4V4
DEV: ;CNTR: ; OWN: CNSLT/ENG:G2/lvm �e}
OTHER ALIASES: rtk oa,,-s A-vc
Circle Size of Waterline: " 10" 12" Circle One: New/Replace/Extension
Circle Size of Sewerline: �18;
10" 12" Circle One: New/Replace/Extension
Circle Size of Stormline: ' 18" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
-R, TED ❑
(off site improvements) (include TESC)
❑ TRO ❑ ❑
(Signalization,Channelization,Lighting)
WWP ❑
(sanitary sewer main,include basin name)
WTR ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
SWP ❑ ❑
(CIP onlyxinclude basin name)
lY 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
. s. F
a
.�s