HomeMy WebLinkAboutSWP273642 PROJECT REQUEST FORM
PLANNING/BUILDING/PUBLIC WORKS
�DATE�:7�31�(Ll�-2— �CbNTAC�T- (� EXT.
FILE STATUS ❑NEW OR ❑ EXISTING: FILE CODE(rlu-xx-xxxx):
LOCATION ❑ My Work Space:
❑ File.Bay Shelf#: ❑ Other:
All
PROJECT NAME/FILE TITLE }► 1m q Pr M:
(70 characters max)
DESC TION OF PROJECT: -
1a� , m tm
r
d C
UTILITY PERMIT# LUA#. WO#
ADDRESS/STREET NAIVIE(S):
`` N: V+ NSLT/ENG: t3Tt 6
DEV:CFA'������R: OW
-- -OTBER_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: 18" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT
Ltr Drwg #of sheets
D ❑ ❑
(off site improvements) (include TESC)
❑ ❑
❑ TRO
(Signalization,Channelization,Lighting)
❑ WWP
(sanitary sewer main,include basin name)
ElEl WTR ❑ (inc.composite&HorizontalCtrl)
(Mains,Valves,Hydrants)
El 11
—Wp (CIP only)(include basin name)
❑/ PLR (For Developer Files Only) ❑ Qetter only)
PLEASE CIRCLE THE DISCIPLINES WffiCH NEED TO SIGN MYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE
FOR FILE 113AINTAINANCE USE ONLY
File Codes File Alias Date Entered and Labels Made