HomeMy WebLinkAboutSWP273463 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE CONTACT: G,;� � eyE
FILE STATUS , f NEW OR ❑ EXISTING: FILE CODE(PRI-xx-xxxx):
LOCATION My Work Space: ❑ File Bay Shelf#: ❑ Other:
[PR:OJEC:TN:A:ME/:FILE TITLE:��/,�l"- ,5�� �j-� f;�-T
(70 characters max)
DESCRIPTION OF PROJECT:
UTILITY PERMIT# LUA# WO#
ADDRESS/STREET NAME(S): /4?2AIAO S7—
DEV: ; CNTR: ; OWN: ; CNSLTBNG:
OTHER ALIASES:
Circle Size of Waterline: 8" 10" 12" Circle One: New/Replace/Extension
Circle Size of Sewerline: 10" 12" Circle One: New/Replace/Extension
Circle Size of Stormline: 12" 18" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE fNVOLVED IN PROJECT Ltr Drwg #of sheets
11�4ED ❑ ❑ 447
(off site improvements) (include TESC)
❑ TRO ❑ ❑
(Signalization,Channelization,Lighting)
❑ WWP ❑ ❑
(sanitary sewer main,include basin name)
❑ WTR ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
S WP El ❑
v —/ (CIP only)(include 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 '