REQUEST FOR COLLECTION SYSTEM NUMBERING
To: Daniel Anderson, GIS Coordinator
Contact Information
Last Name
*
First Name
*
Firm Name
*
Address
*
Apt/Unit
City
*
Select....
Alva
Estero
Fort Myers
Fort Myers Beach
Matlacha
Matlacha Isles
North Fort Myers
Pine Island
State
*
Zip
*
Phone
*
Extension
Email
Request Information
Requests must be accompanied with a master utility plan in pdf and AutoCAD format. Master Utility Plans shall only show infrastructure to be owned/maintained by LCU
Project Name
*
Numbering Requested
*
Lift Stations(s)
Manhole(s)
Total number of Lift Stations at build-out:
*
Total number of Lift Stations in current phase:
*
Total number of Manholes at build-out:
*
Total number of Manholes in current phase:
*
Site Address/Location
*
Apt/Unit
City
*
Select....
Alva
Estero
Fort Myers
Fort Myers Beach
Matlacha
Matlacha Isles
North Fort Myers
Pine Island
State
*
Zip
*
Please list all STRAP Numbers.
STRAP Number
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Documentation
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An electronic or manual signature is required when submitting this form. Write your name in the signature area to submit this form electronically (acceptable per Florida Statue 668.50). If an electronic signature is not possible, the form may be printed, signed and submitted in person, via FAX, or by a scanned copy sent via e-mail.
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STRAP Number
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