HomeMy WebLinkAboutSWP273400 PROJECT REQUEST FORM
PLANNING/BUILDING/PUBLIC WORKS
DATE: CONTACT: XT.
FILE STATUS ❑ NEW OR ❑ EXISTING: FILE CODE(PRI-xx-xxxx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: T ❑ Other:
PROJECT NAME/FILE TITLE: j' /�D�ob / �X��� 'SA&'t / jt,
(70 characters max)
DES�RIPTION OF PROJECT
M al/U3 he, S /
UTILITY PERMIT# 0 -7 C1 Q LUA# D 72 WO# C�
�DD�tS/S ET NAME(S):EV: �' /ltv�� ; CNTR: ; OWN: ; CNSLT/ENG:
OTHER ALIASES:
L
cle 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
CHEC EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
VTED
(off site improvements) (include TESL)
TRO
(Signalization,Channelization,Lighting)
WWP � ❑
(sanitary sewer main,include basin name)
�WTR -
(Mains,Valves, ydrants) (me.composite&HorizontalCtrl)
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 I File Alias Date Entered and Labels Made
Q — 00
Ai t - J* -
-SZ 7 Oo
t31wo 16ndm
Pkk-- 7 3� �< �7�0