HomeMy WebLinkAboutSWP273399 PROJECT REQUEST FORM
PLANNING/BUILDING/PUBLIC WORKS
DATE: CONTACT: EXT.
FILE STATUS ❑ NEW OR 0 EXISTING: FILE CODE(PRI-xx-xxxx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: 0 Other:
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PROJECT NAME/FILE TITLE: tjone5 4\pe ;�,PV,1'W'1 I10c4ir
(70 characters max)
DESCRIPTION OF PROJECT:
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UTILITY PERMIT# U M ()Q 0(0 - LUUA#� � (0— O� WO# 4 1631
ADD SS/STREET NAME(S): . / ��j V 112-1
DEV: ; CNTR: ; OWN: ; CNSLT/ENG:"dind—
OTHER ALIASES5: I1 yl t�- e
Circle Size of Waterline: 8" 10), 2" Circle One: � eplace/Extension
Circle Size of Sewerline: 10" 12" Circle One: ew Replace/Extension
Circle Size of Stormline: 1 18" 24" Circle One ew Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
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P--'TED ❑ ❑
(off site improvements) (include TES )
SRO ❑ ❑
(Signalization,Channelization,Lighting)
G--WWP ❑ ❑ ,L `
(sanitary sewer main,include basin name)
;2,- WTR ❑ ❑ r.,y,
(Mains,Valves,Hydrants) (inc.,coRW.site&HorizontalCtrl)
P-,SWP ❑ P s
(CIP only)(include basin name)
rYPLR (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=6NEY
File Codes File Alias 'Date Entered and Labels Made
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