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HomeMy WebLinkAboutSWP273319 _PROJECT REQUEST FORM PLANNINGBUILDING/PUBLIC WORKS DATE: 6:46 10 G CONTACT: V L jp,cjj p, ^O,.IESEXT. -+2,-+g FILE STATUS TiIEW OR ❑ EXISTING: FILE CODE(PRI-XX-xxxX): LOCATION y Work Space: ❑ File Bay Shelf#: ❑ Other: PROJECT NAME/FILE TITLE:_ VJ I NJS ni iE lam_ (70 characters max) DESCRIPTION OF PROJECT: G-LCT S No('T' Pc_x' w IVA -st.-We-P, M A-r N, s-rp M wA fYS w.D 4t!5p SeA?\(LCt � �^ , SH-012T 1�LAn' lS L4PCA Try rlo l2Ttk o€' 4c iTsa-P PC. UTILITY PERMIT# Q 5 O(Z 5 LUA# ©Ll— 13 r,,,, WO# ADDRESS/STREET NAME(S): I{S Z4 t I:F te� G DEV: V,$S ; CNTR: ; OWN: bC ,S ; CNSLT/ENG: 8 -Erkh�SC'�1 OTHER ALIASES: Circle Size of Waterline: 8" 10" 12" Circle One: New/Replace/Extension Circle Size of Sewerline: 8" 10" 12" Circle One: Replace/Extension Circle Size of Stormline: 12" 18" 24" Circle One ew Replace/Extension CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets if TED ❑ ❑ (off site improvements) (include TESC) TRO (Signalization,Channelization,Lighting) ❑ ❑ WWP ❑ ❑ (sanitary sewer main,include basin name) ❑ WTR ❑ ❑ (Mains,Valves,Hydrants) (inc.cornposite&HorizontalCtrl) lid S WP ❑ ❑ (CIP onlyxinclude basin name) T PLR (For Developer Files Only) ❑ (letter only) PLEASE CIRCLE THE DISCIPLINES WINCH NEED TO SIGN MYLARS WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE FOR FILE MAINTAINANCE USE ONLY t� File Codes File Alias Date Entered and Labels Made