HomeMy WebLinkAboutSWP273398 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: CONTACT: EXT.
FILE STATUS ❑ NEW OR ❑ EXISTING: FILE CODE(PRI-xx-xxxx):
LOCATION O My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE: q N 0
(70 characters max)
DESCRIPTION OF PROJECT:
ney
awe- Tri
UTILITY PERMIT# LUA#0—j-0Q 0 WO# 1� ?O 31
ADDRESS/STREET NAME(S): U cg i
DEV: ; CNTR-6pOIeACM; OWN: !U� ; CNSLT/ENG: �!
OTHER ALIASES: �h J.eK r,c fQ
Circle Size of Waterline: 8" 12" Circle One: e /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
(3' TED ❑ ❑
/ (off site improvements) (include TESC)
C� TRO ❑ ❑
/ (Signalization,Channelization,Lighting)
rer WWP ❑ ❑
(sanitary sewer main,include basin name)
�WTR 11 ❑
/ (Mains,Valves,Hydrants) (me.composite&HorizontalCtrl)
Y SWP ❑ ❑
(CIP onlyxinclude basin name)
PLR (For Developer Files Only) ❑ (letteronly)
PLEASE CIRCLE THE DISCIPLINES WHICH NEED TO SIGN MYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE
FOR FILE MAMAINANCE USE ONLY
File Codes File Alias Date Entered and Labels Made
f ter-.
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