HomeMy WebLinkAboutSWP273649 PROJECT REQUEST FORM
PLANNING/BUILDING/PUBLIC WORKS
DATE: CONTACT: EXT. '
FILE STATUS 0 NEW OR 0 EXISTING: FILE CODE(PRI-xx-xxxx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE_ TITLE: 11 n4 e V
(70 characters max)
DEWP,IPTION 0,F PROJECT
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UTILITY PERMIT# LUA# ( Q— Q Ca 4 WO# Cj
ADDRESS/STREET NAME(S):� ocv) �
DEV:K 6-.5 [1-V ; CNTR: OWN: ; CNSLT/ENG:
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 Storraline: 12" 18" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
/TED ❑ ❑
(off site improvements) (include TESC)
TRO 0 ❑
(Signalization,Channelization,Lighting)
�wwP ❑ ❑
(sanitary sewer main,include basin name) .
/WTR ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
SWP ❑ ❑
(CIP only)(include basin name)
❑ PLR (For Developer Files Only) ❑ (letter only)
PLEASE CIRCLE THE DISCIPLINES WHICH NEED TO SIGN MYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE
FOR FILE MAMAINANCE USE ONLY
File Codes r File Alias l Date Entered and Labels Made
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