HomeMy WebLinkAboutSWP273405 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: /4 7-047 CONTACT: EXT.
FILE STATUS ❑ NEW OR ❑ EXISTING: FILE CODE(PRI-xx-xxxx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE: f✓-P / �iL
(70 characters max)
DESCRIPTIO OF PROJECT:
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UTILITY PERMIT# * -700 LUA# WO#
ADDRESS/STREET NAM (S): 060 71i, .,�,ti AAl Y1 E 9A j�
DEV:&—tO, S�R � ; OWN: ; CNSLT/ENG:
OTHER ALIASES:
Circle Size of Waterline: 8" 12" Circle One: New/Replace/Extension
Circle Size of Sewerline: 8" 10" 12" Circle One: New/Replace/Extension
Circle Size of Stormline: 18" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
TED ❑
(off site improvements) (include TESC)
V '` O d-/ oux
/WWP (Signalization,Channelization,Lighting)
(sanitary sewer main,include basin name)
0" WTR /k//
(Mains,Valves,Hydrants) (inc.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 File Alias Date Entered and Labels Made
ft ,�t_oQ
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