Required Information:
Project Name:
Project Location:
Requestor Name:	Phone Number:
Address:	Email Address:
Project Type: (Road, Water, Park...etc)	Commissioner: (Please refer to District Map)

Project Benefits: (Describe need for project, public benefits, urgent issues)
Project Scope: (Size and type of project, detailed cost and location)
Estimated Project Cost	Project Cost per Year	Total
2014	2015	2016	2017	2018
Design / Planning	$	$	$	$	$	$
Construction	$	$	$	$	$	$
Land Purchase	$	$	$	$	$	$
Total Project Cost	$
Additional Information : Please complete this section if possible (not required)
When can construction start? (6mo, 1 yr…etc.)	Will requested funds be used with other funding?
Is this project within Sustainable Development Area 1, 2 or 3 if known? (Please refer to SDA Map)	Is project described in a planning document? (such as a community plan)
Explain how this project will improve this area?
Fiscal Impact	Operational Cost per Year	5 year Average
2014	2015	2016	2017	2018
Operation & Maintenance	$	$	$	$	$	$
Signature:	Date: