HomeMy WebLinkAboutSWP273443 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: CONTACT: L r EXT.
FILE STATUS NEW OR ❑ EXISTING: FILE CODE(Plu-xx-xxxx):
LOCATION My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROTECT NAME/FILE TITLE: 4l!i 1) 4t,,
0_characters max)
DESCRIPTION OF PROJECT-
/ f
UTILITY PERMIT# 6/0 SOO 0 LUA# WO#
ADDRESS/STREET NAME(S): /& /"ai o. « _ J
DEV: ; CNTR: ; OWN: ; CNSLT/ENG:
OTHER ALIASES: H C 06_�'e rl 441 vi r 6/_✓ /,t,_x ,
Circle Size of Waterline: K(,-,
8" 101, 12" Circle One: New Replace/Extension
Circle Size of Sewerline: 8" l 0" 12" Circle One: New Replace/Extension
Circle Size of Stor aline: 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)
wwP ❑ ❑
(sanitary sewer main,include basin name)
WTR ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtri)
❑ SWP ❑ ❑
(CIP only)(include basin name)
,0' PLR (For Developer Files Only) ❑ (letter only)
SEC CLE THE DISCIPLINES WFIICH NEED TO SIGN MYLAR.S
WATE WASTEWATER SURFACE WATER TRANSPORTATION FIRE
FOR FILE MAINTAINANCE USE ONLY
File Codes File Alias Date Entered and Labels Made
L•