HomeMy WebLinkAboutSWP273340 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: q 2/ a CONTACT: EXT.
FILE STATUS NEW OR ❑ EXISTING: FILE CODE(PRI-xx-xxxx)=
LOCATION WMy Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE: Ski y trrP �l�
(70 characters max)
DESCRIPTION OF PROJECT:
Arrar�,w D
Lef Pl.z
UTILITY PERMIT# LUA# d - 6k:;75 WO#
ADDRESS/STREET NAME(S): Q r;rc i 12`7 �T��i cLl 41, la.4, Alr�t
DEV:(�04' &— ; CNTR: ;OWN: ; CNSLT/ENG: i�.✓
OTHER ALIASES: 977 57t.= 2t'lp B L 7'Z S'4r-- t'ds'/-
Circle Size of Waterline: 10" 12" Circle One: VNe
Replace/Extension
Circle Size of Sewerline: 10" 12" Circle One: Replace/Extension
Circle Size of Stormline: � 18" 24" Circle OneReplace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
I TED ❑
(off site improvements) (include TESC)
❑ TRO ❑ '❑
(Signalization,Channelization,Lighting)
WWP ❑ kE]
(sanitary sewer main,include basin name)
WTR ❑
(Mains,Valves,Hydrants) (inc.composite&Horizontaictrl)
❑ SAT ❑ ❑
(CIP only)(include basin name)
PLR (For Developer Files Only) 1' etter on y
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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