HomeMy WebLinkAboutSWP273338 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: _6_p CONTACT: ZTU w 4;;?-.4 8S EXT. -I-
FILE STATUS W OR ❑ EXISTING: FILE CODE(PRI-xx-xxxx):
LOCATION 2-My Work Space: 10 File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE: l-V t Cat}LPr PrtxS PH-R•tt
(70 characters max)
DESCRIPTION OF PROJECT:
MP/LOVE7K�,1r-S ,n1C ��s�1f S� 429 sT SE IS?o ' ST
W f1- 1Z ZVW 2I C-;" -+90
UTILITY PERMIT# 0 jo10;O O 8 y LUA# OS—1 Z q W O#
ADDRESS/STREET NAME(S): 1 L S , t/gS7-pq AN E' /ViE7
DEV: 31y21�ST+e ; CNTR:6 ,b0q MWcy &b; OWN: BUf2NS CNSLT/ENG: 004?e- fig,
OTHER ALIASES:
Circle Size of Waterline: 8" 10" 12" Circle One: (N,;w 1 Replace/Extension
Circle Size of Sewerline: (0 10" 12" Circle One: e Replace/Extension
Circle Size of Stormline: 12' 18 24" Circle One e /Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
,P- TED ❑ ❑
(off site improvements) (include TESC)
..P--TRO ❑ ❑
(Signalization,Channelization,Lighting)
�WWP ❑ ❑
(sanitary sewer main,include basin name)
❑ WTR ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
SWP ❑ ❑
/ (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
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