HomeMy WebLinkAboutSWP273397 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: CONTACT:jqll rd EXT.
FILE STATUS ❑ NEW OR ❑ EXISTING: FILE CODE(Plu-xx-xxxx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE:�Y`�_V4ern f;—,? P
(70 characters mac)
pa V
DESCRIPTION OF PROJECT: r
—ICA, moil -T-n-n�I�Tfi & <if/L;i eura It- , r- Orr-? �--
UTILITY PERMIT# U 0 JM� _ LUA#_ O G- fia wo# `3-7 a 3
ADDRESS/STREET NAME(S):
DEV:�YYA�}�!_!�6 ; CNTR: ; OWN: ; CNSLT/ENG: D V�
OTHER ALIASES: Aolna be-q
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
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
TE ❑ ❑
(off site improvements) (include TESC)
❑ O ❑ ❑
(Signalization,Channelization,Lighting)
❑ ❑
/ (sanitary sewer main,include basin name)
❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
V❑ SWP ❑ ❑
(CIP only)(include basin name)
PLR (For Developer Files Only) ❑ (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