HomeMy WebLinkAboutSWP273572 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: )0 c l/ U CONTACT: � ��p� EXT.
FILE STATUS ❑NEW OR ❑ EXISTING: FILE CODE(Plu-XX-XXXX):
LOCATION ❑ My Work Space: FO File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE: akzeda
( 0 ha. cters max)
DESCRIPTION OF PROJECT: ,
UTILITY PERMIT# 14 00 �4-�- LUA# �-- ✓L— WO# ' G
ADDRESS/STREET NAME(S):
DEV: ; CNTR: ; OWN: ; CNSLT NG:
OTHER ALIASES:
Circle Size of Waterline: 8" 10" 12" Circle One: New/Replace/Extension
Circle Size of Sewerline: 8" 101, 12" Circle One: New/Replace/Extension
Circle Size of Stonnline: 12" 1.8" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
-01"TED
(off site improvements) (include TESC)
❑ TRO ❑ ❑
(Signalization,Channelization,Lighting)
❑ WW1, ❑ ❑
(sanitary sewer main,include basin name)
❑ WTR ❑ ❑ f
(Mains,Valves,Hydrants) (inc.composite&Horizon ctrl)
WP D ❑
(CIP onlyxinclude basin name)
�LR (For Developer Files Only) ❑ 0etter only)
PLEASE CIRCLE THE DISCIPLINES WMCH NEED TO SIGN MYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE
FOR FILE MAINTAINANCE USE ONLY
��File Codes File Alias Date Entered and Labels Made