HomeMy WebLinkAboutSWP273349 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
CONTACT: (- 0 � 1 �q n EXT. .7 T
FILE STATUS I ❑ NEW OR ❑ EXISTING: FILE CODE(PRi-xx-xxxx):
LOCATION ❑ My Work Space: r❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE: f\i I Lb
(70 ch c rs max)
DESCRIPTION OF PROJECT: It
UTILITY PERMIT# U� (00-1 LUA# 0 S C4 WO# `6(jI Co
ADDRESS/STREET NAME(S): �
DEV: I^VE'` 1� LP CQ0-4-' ; OWN: C 'nq ; CNSLT/ENG:UU H AC4IL
OTHER ALIASES: �r" �-
Circle Size of Waterline: 8" 10 12" Circle One: New Replace/Extension
Circle Size of Sewerline: 8" 10" 12" Circle One: ew/Replace/Extension
Circle Size of Stormline: 12" 18" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
U,/TED ❑ ❑ . `'F to
(off site improvements) (include TESC)
rY TRO ❑ ❑
(Signalization,Channelization,Lighting)
(sanitary sewer main,include basin name)
is 3WTR
•�
(Mains,Valves,Hydrants) (inc.composite'&HorizontalCtrl)
S WP ❑ ❑
(CIP onlyxinclude basin name)
❑v PLR (For Developer Files Only) ❑ getter only)
PLEASE CIRCLE THE DISCIPLINES WHICH NEED TO SIGN MYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE
FOR FILE MAINTAINANCE USE ONLY
�s File Codes File Alias Date Entered and Labels Made
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