HomeMy WebLinkAboutSWP273665 PROJECT REQUEST FORM
PLANNINGBUILDING/PIMLIC WORKS
DATE: Z� 3 CONTACT: � ��/ EXT.
FILE STATUS ❑NEW OR. ❑ EXISTING: FILE CODE.(Ptu-xx- :
LOCATION ❑ My Work Space. ❑ File Bay Shelf#: ❑ Other-
PROJECT NAME/FILE TITLE:
(70 characters max)
DESCRIPTION OF PROJECT: V 12 1 1 n
IJTITI TI'Y E # !a O i 2 LUA# l Z - 0 7WO#
ADDRESS/S ET NAME(S):/ ( s is A/'� ✓ e ��,,�,S�
DEV: ; CNTR: 1 5 �;�OWN: ; CNSLT/ENG: L S
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 Stormline: 2' 18" 24" Circle One New/Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg #of sheets
Cg%iTED. 0� C
(off site improvements) (include TESC)
(Signalization,Channelization,Lighting)
(sanitary sewer main,include basin name)
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
(CIP only)(mclude basin name)
.(For Developer Files Only) ❑ (letter only)
PLEASE CIRCLE THE DISCIPLINES WHICH.NEED TO SIGN MYLARS
WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE t,
FOR FILE MIMTAINANCE USE ONLY
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File Codes File Alias Date Entered and Labels Made
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