HomeMy WebLinkAboutSWP273371 PROJECT REQUEST FORM
PLANNING/BUILDING/PUBLIC WORKS
DATE: Z7 CONTACT: _ an _ I !Cf Y EXT.
FILE STATUS ❑ NEW OR ❑ EXISTING: FILE CODE(PPd-xx-xxxx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE: T1 tf LXA Y1Cl 1 11 � _ - - L+
(70 charac ax)
DESCRIPTION OF PROJECT:
1` ( C t (i Il Cl
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UTILITY PERMIT# C ,�C�Cr` i �C C{ LUA# Cn> — .?j WO#
ADDRESS/STREET NAME(S): °CaC n. 4Q< `
DEV: r u awl t rR: f t C t Y1; J �� 1� CNSLT/ENG: ��-1�
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OTHER ALIASES: Lo1
CircleISizef Waterline: 8" 4 12" Circle One: ew Replace/Extension
Circlef Sewerline: 8" 10" 12" Circle One: New/Replace/Extension
Circlef Stormline: 18" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
❑ TED ❑ ❑
(off site improvements) (include TESC)
❑ TRO ❑ ❑
(Signalization,Channelization,Lighting)
❑ WWP ❑ ❑
(sanitary sewer main,include basin name)
❑ WTR ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
❑ S WP ❑ ❑
(CIP onlyxinclude basin name)
❑ PLR (For Developer Files Only) ❑ (letter only)
PLEASE CIRCLE THE DISCIPLINES WIHCH 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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