HomeMy WebLinkAboutSWP273370 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: -Z, CONTACT: EXT.
FILE STATUS ❑ NEW OR ❑ EXISTING: FILE CODE(PRl-xx-atxxx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE: A,,e Z
(7-0 characters max)
DESC TION OF PROJECT: �Z����
Go c2 �D !l�-r
U 'M/1A PERMIT# C OA2 r j LUA# i — �_ WO#
ADDRESS/STREET NAME(S): `r 7�h /" S l �%��� Ale
DEV: /fe -CNTR: ; OWN: ; CNSLT/ENG;.&i'caf7c
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OTHER ALIASES:
Circle Size of Waterline: /8 10" 12" Circle One: e Replace/Extension
Circle Size of Sewerline: 8" 10" 12" Circle One: New/Replace/Extension
F
Circle Size of Stormline: 12" 18" 24" Circle One New/Replace/Extension
CHEC EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
TED ❑ ❑
(off site improvements) (include TESC)
❑ TRO ❑ ❑
(Signalization,Channelization,Lighting)
❑ W WP ❑
(sanitary sewer main,include basin name)
�Q WTR ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
❑ SWP ❑ ❑
(CIP only)(include basin name)
❑ PLR (For Developer Files Only) ❑ (letter only)
PLEASE CERCLE 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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