HomeMy WebLinkAboutSWP273701 PROJECT REQUEST FORM
PLANNINGBUILDING/PUBLIC WORKS
DATE: CONTACT: 1 'u EXT.
FILE STATUS ❑ NEW OR ❑ EXISTING: FILE CODE(PRI-xx-xxxx):
LOCATION ❑ My Work Space: ❑ File Bay Shelf#: ❑ Other:
PROJECT NAME/FILE TITLE: N_eY'i � I l�� U ►''� �5
(70 characters max)
DESCRIPTION OF PROJECT:
UTILITY PERMIT# LUA# — d G I WO# (�
ADDRESS/STREET NAME(S):� Q
DEV: ; CNTR: ; OWN ; CNSLT/ENGT� G�
OTHER ALIASES: 066
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: 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 ❑ ❑
(Signalization,Channelization,Lighting)
�j V�I�IP ❑ ❑
(sanitary sewer main,include basin name)
W jR ❑ ❑
(Mains,Valves,Hydrants) (inc.composite&HorizontalCtrl)
%1§- SWP ❑ ❑
(CIP only)(include basin name)
PLR (For Developer Files Only) ❑ (letter only)
P CIRCLE THE S WHICH NEED TO SIGN MYLARS
WATE W STEWATER URFACE WA TRANSPORTATION FIltE
FOR FILE MAINTAINANCE USE ONLY
File Codes File Alias Date Entered and Labels Made
'C 10
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