HomeMy WebLinkAboutSWP273643 PROJECT REQUEST FORM
PLANNING/BUILDING/PUBLIC WORKS
DATE: j{ - I ZrCONTACT: EXT.
.FILE STATUS ❑NEW OR ❑ EXISTING: FILE CODE(PPJ-XX-7 XXX):
LOCATIOPt ❑ My Work Space: . ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE=E
(70 character max)
DESCRIPTION OF PROJECT:
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UTILITY PERMIT# //! 12 C6LUA# y /Z C) 2�WO#
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ADDRESS/STREET NAME(S): / l v Ci SG�•^-c� -�
DEV:AOL CNTR.- ; OWN: ; CNSLT/ENG: T G I
OTBER ALIASES:
Circle Size of Waterline: 10" 12" Circle One- New/Replace/Extension
Circle Size of Sewerline: 8" 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
'•TED ❑ ❑
(off site improvements) (include TESL)
❑ TRO ❑ ❑
(Signalization,Channelization,Lighting) /.
(sanitary sewer main,include basin name)
�TR - ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtr{)
❑ S WP ❑ ❑
(CIp only)(include basin name)
LR (For Developer Files Only) ❑ (letter only)
PLEASE CIRCLE THE DISCIPLINES WHICH NEED TO SIGN MYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION - FIRE
FOR FILE MIMAINANCE USE ONLY
-File Codes 'File Alias Date Entrxed and Labels Made
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