HomeMy WebLinkAboutSWP273341 PROJECT REQUEST FORM
PLANNING/BUILDING/PUBLIC WORKS
DATE: Z ) S a CONTACT: EXT.
FILE STATUS 0 NEW OR ❑ EXISTING: FILE CODE(Plu-XX-XXXX):
LOCATION 0 My Work Space: 1.0 File Bay Shelf#: O Other:
PROJECT NAME/FILE TITLE:
(70 chars )
DESCRIPTION OF PROJECT:
UTILITY PERMIT# LUA# ('3'— L WO# O 7 D-3
ADDRESS/STREET NAME(S): /
DEV: ;CNTR: ;O ;CNSLT/ENG:
OTHER ALIASES:
Circle Size of Waterline: 8" 10" 12" Circle One: New/Replace/Extension
Circle Size of Sewerline: 8" 10" 12" Circle One: New/Replace/Extension
Circle Size of Stormline: 12" 18" 24" Circle One New/Replace/Extension
CfMCK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
TED �� ❑
(off site improvements) (include TFSC)
(Signalization,Channelization,Lighting)
n WWP �� ❑
(sanitary sewer main,include basin name)
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
❑ SAT ❑ ❑
(CIP only)(include basin name)
0 PLR (For Developer Files Only) D (letter only)
PLEASE CIRCLE THE DISCIPLINES WHICH NEED TO SIGN MYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE
FOR FELE MAINTAINANCE USE ONLY
File Codes File Alias Date Entered and Labels Made
0.�
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