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Short Plat (SHPL# )
REQUEST FOR PROJECT# Prelim.Plat (PP# )
CAG# )
To: Technical Services Date 3 - S —q ' WO# Z 7 96 7 Green#
From: Plan Review/Project Managers ykF7,U
Project Name U aJ L" 106A--p
(70 characters max)
Description of Project:
Circle Size of Waterline: 8" 10" 12" Circle One: New or Extension
Circle Size of Sewerline: 8" 10" 12" Circle One: New or Extension
Circle Size of Stormline: 12" 15" 18" 24" Circle One: /Neww or Extension
Address or Street Name(s) �� i C-'j Gc�� �i(/ V •y -e
Dvlpr/Contractor/Owner/Cnslt:: -
(70 characters max)
Check each discipline involved in Project Ltr Drwg #of sheets per discipline
❑Trans-Storm ❑ ❑
(Roadway/Drainage) (Off site improvementsXinclude basin name) (include TESC sheets)
❑ Transportation (Signalization,Channelization,lighting) ❑ Cl
(lam Wastewater ❑ ❑
Sanitary Sewer Main(include basin name)
Q-' Water (Mains,Valves,Hydrants) ❑ ❑
(Include composite&Horizontal Cui Sheets)
❑ Suface Water ❑ ❑
Improvements (CIP ONLY)(include basin name)
TS Use Only I C�' i7� - �� Cl)