HomeMy WebLinkAboutSWP273320 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: el
(70 characters max)
DESCRIPTION OF PROJECT:
//
UTILITY PERMIT# UA1 LUA# ® 5--®f 3 WO#
ADDRESS/STREET NAME(S): 1/t✓✓r4 co kk'Z /y Vic roll
DEV: ; CNTR: ; OWN:} '�T1 _ ; CNSLT/ENG: CJ
OTHER ALIASES:
Circle Size of Waterline: VY-) l
0" 12" Circle One: New/Replace/Extension
Circle Size of Sewerline: 0" 12" Circle One: New/Replace/Extension
Circle Size of Stormline: 8" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
TED (off site improvements) (include
y
(include TESC)
TRO El(Signalization,Channelization,Lighting)
ywWP ❑
(sanitary sewer main,include basin name)
WTR (Mains,Valves,Hydrants) � �
(inc.composite&HorizontalCtrl)
S WP (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 FILE MAINTAINANCE USE ONLY
File Codes File Alias Date Entered and Labels Made
a0
0-4