HomeMy WebLinkAboutSWP273450 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: 22 O v ONTACT: 4
F IA4, EXT.
FILE STATUS 1 ❑ NEW OR ❑ EXISTING: FILE CODE(PIu-xx-xxxx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: ❑ Other:
P
PROJECT NAME/FILE TITLE:
(70 characters max)
DESCR}P ION OF PROJECT:
// 2
OF
UTILITY PERMIT#14 _ LUA#_� / 03 WO# -7n3
ADDRESS/PREET NAME(S): 22,
DEV: ; CNTR: ; OWN: ; CNSLT/ENG: C5,dl
OTHER ALIASES:
Circle Size of Waterline: 10" 12" Circle One: New/Replace/Extension
Circle Size of Sewerline: /S 10" 12" Circle One: New/Replace/Extension
Circle Size of Stormline: Cam- 1122" 18" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
0--- o
(off site improvements) z/ (include TESC)
R ❑ ❑
(Signalization,Channelization,Lighting)
9--W WP
"a ❑
(sanitary sewer main,include basin name)
/ (Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
k- S WP ❑ ❑
/ (CIP only)(include basin name)
C�' 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
rFileodes File Alias Date Entered and Labels Made
-3 If
- ---
a
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