HomeMy WebLinkAboutSWP273587 PROJECT REQUEST FORM
PLANiVINGBUILDING/PUBLIC WORKS J
DATE: 1 4 " cy CONTACT: EXT.
FILE STATUS 0 NEW OR 0 EXISTING: FILE CODE(PRI-XX-XXXX):
LOCATION ❑ My Work Space: 0 File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE:
(70 characters max)
DESC TION F P OJE.CT: � '
.r-e
UTILITY PERMIT# V// 0 0 42 LUA# �/� ' � 96 WO# 0 3
ADDRESS/STREET NAME(S): 7` �
DEV: . ; CNTR: OWN: ; CNSLT NG•
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: 1.8" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
TED 17�
(off site improvements) (include TESC)
c (Signalization,Channelization,Lighting)
(sanitary sewer main,include basin name)
❑ ❑c_--- ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
(CIP onlyXinclude basin name)
(For Developer Files Only) e44-- ` (letter only)
PLEASE CIRCLE THE DISCIPLINES WHICH NEED TO SIGN ATYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE
FOR FILE MAINTAINANCE USE ONLY
File Codes File Aliases Date Entered and Labels Made
O
027 - S' d-