HomeMy WebLinkAboutSWP273442 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
D5/Z It
ATE: - Zp a B 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)
DESCRIPTION_ OF PROJECT:
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UTILITY PERMIT# p 800-Z- LUA# p T— B 12 WO# 6 7®s/
ADDRESS/STREET NAME(S): //S�
DEV Cam- ; CNTR: ; OWN: ; CNSLTIENG:
OTHER ALIASES: WV --
W
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
VTED fir '
(off site improvements) (include TESC)
W'*'TRO c,,-- L i-`y
(Signalization,Channelization,Lighting)
IY WWP � ❑
(sanitary sewer main,include basin name) 7}
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
m'..-S WP ❑ ❑
(CIP only)(include basin name)
�•`'SLR (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
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