HomeMy WebLinkAboutSWP273401 PROJECT REQUEST FORM
PLANNING/BUILDING/PUBLIC WORKS
DATE: 22 CONTACT: EXT.
FILE STATUS ❑ NEW OR ❑ EXISTING: FILE CODE(PRI-xx-xxxx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE:
70 characters max)
DESCRIPT ON OF P O
UTILITY PERMIT# U/ (/ j LUA# /_3 ® p� 7 d-3
ADDRESS/STREET NAME(S):
DEV: ; CNTR: ; OWN: CNSLT/ENG:
OTHER ALIASES:
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
TEDa----
(off site improvements) (include TESC)
❑ TRO ❑ ❑
b �, ,� (Signalization,Channelization,Lighting)
El
(sanitary sewer main,include basin name)
VTR
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
P/S WP ❑ ❑
(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
WFileCodes File Alias Date Entered and Labels Made v
L