HomeMy WebLinkAboutSWP273312 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: L 6 CONTACT: /y11 s, r EXT. 7�
FILE STATUS NEW OR ❑ EXISTING: FILE CODE(PRI-Xx-XXXx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE: Nea,,; PA-r-k 14 EAL&2zr (X.1d ,1AJs 1
(70 characters max)
DESCRIPTION OF PROJECT:
> 12v l
AL
UTILITY PERMIT# LUA# WO#
ADDRESS/STREET NAME(S):
DEV:L14 o /L=r CNTR: ; OWN: ; CNSLT/ENG:
OTHER ALIASES: &j 3 P V C-1 �/ (!lam/a�:w '�Ve
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
TED ❑ Z
1
(off site improvements) (include TESC)
❑ TRO ❑ ❑
(Signalization,Channelization,Lighting)
❑ WWP ❑ ❑
(sanitary sewer main,include basin name)
❑ WTR ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
4X
S WP (CIP onlyxinclude basin narne) ❑ ❑
PLR (For Developer Files Only) ❑ (letter only)
( PLEASE CIRCLE THE DISCIPLINES WHICH NEED TO SIGN MYLARS
7�
WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE
FOR FILE MAINTAINANCE USE ONLY
File Codes File Alias Date Entered and Labels Made
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