HomeMy WebLinkAboutSWP273309 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE � (� CONTACT: : EXT.
FILE STATUS ❑ NEW OR ❑ EXISTING: FILE CODE(PRI-xx-xxxx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE:
(70 chars ers max)
DESCRIPTION OF2A�
OJECT:
/ —
12001
UTILITY PERMIT# U Q(/ LUA# O / to �p WO# ?0 3 .
ADDRESS/STREET NAME(S): /V F
r
DEV: ;CNTR: , OWN: ; CNSLT/ENG:
OTHER ALIASES: 6�-
t t1
Circle Size of Waterline: 10" 12" Circle One: New/Replace/Extension
Circle Size of Sewerline: 8" 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
(off site improvements)
(include TESC)
(Signalization,Channelization,Lighting)
"WP
(sanitary sewer main,include basin name)
�wTR - � ❑ �t/���
(Mains,Valves,Hydrants) (inc.composite&Horizontaictrl)
❑ 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
File Codes File Alias Date Entered and Labels Made
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