HomeMy WebLinkAboutSWP273657 PROJECT REQUEST FORM
PLANNING/BUILDING/PUBLIC WORKS
DATE: Z CONTACT: EXT.
.FILE STATUS ❑NEW OR 0 EXISTING: FILE CODE(P1U-xx-3)oCX).
LOCATION 0 My Work Space.. ❑ File Bay Shelf#: 10 Other:
PROJE NAME/FILE T
o characters max) �� ...,�•a!� r :'
_ pESC -- ON OFP OJECT:-___
UTILITY PERMIT# 2l//��x LUA#_ WO# `� `7 a j/
ADDRESS/STREET NAME(S):
DEV: ; CNTR: ; OWN: ; CNSLVENG: G
OTHER ALIASES:
Circle Size of Waterline: 10" 12" Circle One: . Ne /Replace/Extension
Circle Size of Sewerline: 8" 10" 12" Circle One: ew/Replace/Extension
Circle Size,of Stormline: I2" 18" . 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
(off site improvements) (include TESL)
-❑ TRO El ❑
(Signalization,Channelization,Lighting)
W W Y 41__� ❑
(sanitary sewer main,include basin name)
l/
❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrt)
❑ SWP 0 ❑
(CIP only)Cmclude basin name) -
/ LR (For Developer Files Only) ] .A'�/patter only)
PLEASE CIRCLE THE DISCIPLINES WBICHVEED TO SIGN MYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE
FOR FILE MAMTAINANCE USE ONLY
-File Codes I File Alias I Date Entered and Labels Made
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