HomeMy WebLinkAboutSWP273348 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: - L'} CONTACT: EXT.
FILE STATUS ❑ NEW OR ❑EXISTING: FILE CODE(PRI-XX-XXXX):
LOCATION ❑ My Work Space: 0 File Bay Shelf#: ❑ Other.
PROJECT NAME/FILE TITLE: /�'Ul.
(70 characters max)
DESCWTTION.QF PROJECT:
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1me `
��J t j
UTILITY PERMIT# �'!e / LUA# WO# Cq
ADDRESS/STREET NAME(S): 16
DEV: ;CNTR: ;OWN: ; CNSLT/ENG:
OTHER ALIASES:
Circle Size of Waterline: 8" 10" 12" Circle One: New/Replace/Extension
Circle Size of Sewerline: _ 10" 12" Circle One: Ne /Replace/Extension
Circle Size of Stomiline: 18" 24" Circle One w Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
(off site improvements) (include TESL)
0 TRO O ❑
(Signalization,Channelization,Lighting)
(sanitary sower main,include basin name)
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
. SWP ❑ O
(CIP onlyxinclude basin name)
'PLR (For Developer Files Only) O (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
40
1 A
-
.