HomeMy WebLinkAboutSWP273654 PROJECT REQUEST FORM
PLANNING/BUELDING/PUBLIC WORKS
DATE: � 7 ii/Z�CONTACT: EXT.
FILE STATUS ❑NEW OR ❑ EXISTING: FILE CODE(PRI-XX-xX)C)_
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: 0 Other:
PROJECT NAME/FILE TITLE: /�O-yY-� `�-- �CS�
(70 characters max)
DESCRIPTION OF PROJECT: .
UTILITY PERMIT# I Z Gl o � LUA# l z f C G' � W0# 7 C,S
ADDRESS/STREET NAME(S): j 2 -33 C
DEV: ; CNTR: ; OWN: ; CNSLT/ENG:
OTHER ALIASES:-LaL -I.GL�
Circle Size of Waterline: 8" 10"- 12" Circle One: e /Replace/Extension
Circle Size of Sewerline: 10" 12" Circle One: Ne /Replace/Extension
Circle Size of Storniline: 12 18" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg # of sheets
(off site improvements) (include TESC)
(Signalization,Channelization,Lighting) ^ /
za W Y `lam CE
(sanitary sewer main,include basin name)
Ca, Y1 1 R "LJ
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
❑ SWP ❑ ❑
/ (CIP only)(include basin name) /
(�� PLR (For Developer Files Only) 0 (letter only)
PLEASE CIRCLE THE DISCIPLINES WEICH.NEED TO SIGN MYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE
FOR FILE MXMA-NANCE USE ONLY
File Codes File Alias Date Entered and Labels Made