HomeMy WebLinkAboutSWP273460 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE:,� O,!�!) CONTACT: / — EXT.
FILE STATUS NEW OR ❑ EXISTING: FILE CODE(Plu-xx-xxxx):
LOCATION 0 My Work Space: ❑ File Bay Shelf#: 0 Other:
PROJECT NAME/FILE TITLE.` —_
(70 characters max)
DESCRIPTION OF PROJECT:
2 G 721,1
hf
UTILITY PERMIT# LUA# WO#
ADDRESS/STREET NAME(S):
DEV: ; CNTR: ; OWN: ; CNSLT/ENG:
OTHER ALIASES: St2 O 2
F
le Size of Waterline: 8" 101, 12" Circle One: /Replace/Extension
le Size of Sewerline: 8" 10" 12" Circle One: �Veplace
eplace/Extension
le Size of Stormline: 12" 18" 24" Circle One /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.com
posite mposite&HorizontalCtrl)
li�/ SWP ❑ ❑
(CIP onlyxinclude basin name)
V' 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
File Codes File Alias Date Entered and Labels Made
Al