HomeMy WebLinkAboutSWP273422 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: CONTACT: C0 EXT- p�
FILE STATUS 0 NEW OR ❑ EXISTING: FILE CODE(PIu-XX-XXXX):
LOCATION 0 My Work Space: ❑ File Bay Shelf#: 0 Other:
PROJECT NAME/FILE TITLE: ` ed
(70 characters max)
DESCRIPTION OF PROJECT:
ca l�'Y-1 nVA M 1 t Yl C
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UTILITY PERMIT# �_ LUA# dI ` __� 11 WO# Cl
ADDRESS/STREET NAME(S): 11a1 �7�'r
DEV I�t r11 OWN: ; CNSLT/ENG:� ' (5
OTHER ALIA Y'
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
TED ❑ ❑
(off site improvements) (include TESC)
®/TRO ❑ ❑
(Signalization,Channelization,Lighting)
1 /W ❑ ❑
(sanitary sewer main,include basin name)
U//WTR ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
❑ ❑
(CIP onlyxinclude basin name)
PLR (For Developer Files Only) ❑ (letter only)
PLEASE CIRCLE THE DISCIPLINES WHICH NEED TO SIGN MYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION FI E
FOR FII.E MAINTAINANCE USE ONLY
File Codes File Alias Date Entered and Labels Made
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027 - e
fi 7 ` s•/ r