HomeMy WebLinkAboutSWP273222 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: S CONTACT: , EXT.
FILE STATUS ❑NEW OR ❑ EXISTING: FILE CODE(Plu-xx-xxxx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: 0 Other:
PROJECT NAME/FILE TITLE: CZ (70 characters max)
DESCRIPTION OF PROJECT:
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UTILITY PERMIT# 62 LUA# WO# 6-1 03/
ADDRESS/STREET NAME(S):
DEV: "°tNTR: ; OWN: ` ; CNSLT/ENG:
OTHER ALIASES:
Circle Size of Waterline: 8" 10" 12" Circle One: New/Replace/Extension
Circle Size of Sewerline: 8" 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
❑ TED ❑ ❑
(off site improvements) (include TESC)
❑ TRO ❑ ❑
(Signalization,Channelization,Lighting)
(sanitary sewer main,include basin name)
❑ WTR ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
❑ SWP ❑ ❑
(CIP onlyxinclude basin name)
❑ PLR (For Developer Files Only) ❑ getter only)
PLEASE CIRCLE THE DISCIPLINES WHICH NEED TO SIGN MYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE
FOR FILE MAINTAINANCE USE ONLY
n File Codes File Alias Date Entered and Labels Made
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