HomeMy WebLinkAboutSWP273333 PROJECT REQUEST FORM
PLANNING/BUILDING/PUBLIC WORKS
DATE: p CONTACT: a EXT. � v c�
FILE STATUS ly±TW OR ❑ EXISTING: FILE CODE(Plu-XX-xXXX):
LOCATION My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITT.E:__
(70 characters max)
DESCRIPTIO OF PROJECT:
J
UTILITY PERMIT#—�Ieegle 5F etle LUA# �5-- /5fS" WO#
ADDRESS/STREET NAME(S): I/!t G kc IV Ol
DEV: �fJ'a ;CNTR: ; OWN: ; CNSLT/ENG:
OTHER ALIASES:
Circle Size of Waterline: IV10" 12" Circle One: /Replace/Extension
Circle Size of Sewerline: 1110" 12" Circle One: /Replace/Extension
Circle Size of Stormline: 21s' 18" 24" Circle One /Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
TED ,nCude 7�sc)
(off site improvements)
❑ TRO ❑ ❑
(Signalization,Channelization,Lighting)
WWP ❑
l (sanitary sewer main,include basin name)
WTR (Mains,Valves,Hydrants) ❑ (inc.composite&HorizontalCtrl)
SWP ❑ ❑
(CIP only)Cinclude 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 KALMAINANCE USE ONLY
File Codes File Alias Date Filtered and Labels Made