HomeMy WebLinkAboutSWP273703 PROJECT REQUEST FORM
PLANNING/BUILDING/PUBLIC WORKS
DATE: ) j CONTACT: Z EXT. -1 2c7 g
.FILE STATUS W NEW OR .❑ EXISTING: FILE CODE(rxr-xx-X)m'):
LOCATION ❑ My Work Space: . ❑ Pile Bay Shelf#: ❑ Other.
PROJECT NAME/FILE TITLE: - I.V ! 7 S ZRC--ET
C70 characters max)
DESCRIPTION OF PROJECT:
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I-0 T 717t T
27 cqrr
UTILITY PERMIT# LUA# LV l f 3-Qco6/ WO#
3_Ocof47
ADDRESS/STREET NAME(S): f 3 �'f 7 �g@= ?61)10 NC ^7 771 s72ic�
DEV: k�j -` F��P CNTR: ;OWN: ; CNSLT/ENG: F��VI
OTHER ALIASES:
j Circle Size of Waterline: 8" 10" 12" Circle One_ New/Replace/Extension
Circle Size of Sewerline: 8" 10" 12" Circle One: New Replace/Extension
Circle Size of Storrilline: 12." 18" . . 24" -Circle One Netb4 Replace/Extension
CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg , #of sheets
;4 TED. ❑ ❑
(off site improvements) (include TESC)
-❑ TRO ❑ ❑
(Signalization,Channelization,Lighting)
9 VRT ❑ 11
(sanitary sewer main,include basin name)
X WTR ❑ ❑
(Mains,Valves,Hydrants) (mc,composite&HorizontalCtrl)
❑ SWP ❑ ❑
(Cil only)(include basin name.)
❑ PLR .(For Developer Files Only) ❑ (letter only)
PLESE CIRCLET S WHICH.NEED TO SIGN MYLARS
WATER WASTEWA ACE TATER--77 TRANSPORTATION FIRE
FOR FILE MIMAINANCE USE ONLY
File Codes -File Alias Date Ent=d and Labels Made
=-
MA — 7 T