HomeMy WebLinkAboutSWP273289 PROJECT REQUEST FORM
PLANNING/BUILDING/PUBLIC WORKS
DATE: k U CONTACT:X ALr G
FILE STATUS ❑NEW OR ❑ EXISTING: FILE CODE(Plu-xx-xxxx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE:,--.Q
l 7 /
(70 characters max)
DESCRIPTION OF PROJECT:
UTILITY PERMIT# O 3��j LUA# D4'O�J� WO# 7Q 3
ADDRESS/STREET NAME(S): A/3'6 IF
�4 s� 3sl IV
DEV: ;CNTR: ; OWN: ; CNSLT/ENG:
OTHER ALIASES:
Circle Size of Waterline: 8" 10" 12" Circle One: New/Replace/Extension
Circle Size of Sewerline: 8" 10" 12" Circle One: New/Replace/Extension
Circle Size of Stormline: 12" 18" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
V/'TED ❑
(off site improvements) (include TESL)
❑ TRO ❑ ❑
(Signalization,Channelization,Lighting)
❑ WWP ❑ O
(sanitary sewer main,include basin name)
❑ WTR ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&Horizontaluri)
❑ 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 FELE MAINTAINANCE USE ONLY
File Codes File Alias Date Entered and Labels Made
inn
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