HomeMy WebLinkAboutSWP273421 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: CONTACT: �e �
EXT. Z 6
FILE STATUS NEW OR ❑ EXISTING: FILE CODE(PRI-xx-xxxx):
LOCATION My Work Space: 0 File Bay Shelf#: 0 Other:
PROJECT NAME/FILE TITLE:
(70 haracters max)
DESCRIPTION OF PROJE T
e. Z
UTILITY PERMIT# LUA# WO#
ADDRESS/STREET NAME(S):'CXX 5 A) 7" Sr
DEV: ; CNTR: ll ; OWN: ; CNSLT 13 G�
OTHER ALIASES: ,5, V S7—
Circle Size of Waterline: Circle One: New/Replace/Extension
Circle Size of Sewerline: 8" 10" 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)
❑ TRO ❑ ❑
(Signalization,Channelization,Lighting)
V/WWP ❑ ❑
(sanitary sewer main,include basin name)
e/ WTR ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
LCY S WP ❑ ❑
(CIP only)(include basin name)
❑ PLR (For Developer Files Only) ❑ (letter only)
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IRCLE THE WHICH NEED TO SIGN M[YLAT
�ATE�RD �TWA ACE WATE TRANSPORTATION FIRE
FOR FILE MAINTAINANCE USE ONLY
File Codes File Alias Date Entered and Labels Made
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