ISR1-2015 Page 1 of 2
Project Name:
Roadway Identification and Limits:
Name of Street on Final Plat
Section of Street Partial Complete
Section of Street Begins at
Section of Street Ends at
Subdivision Name & Phase (If Applicable):
Check One:
Residential Commercial Light Industrial Heavy Industrial
Wearing Surface
Roadway Total Length
Average Pavement Width
Right-of-Way Width
Pavement Section:
(Materials, SCDOT Designation and Thickness)
Surface Course
Binder Course
Base Course
Underdrains (Right, Left or Both)
Side of The Street(Right, Left or Both)
Curb, Curb And Gutter:
6” Concrete Vertical Curb
6” Granite Curb
Other Curb (Describe)
18” Concrete Roll Curb and Gutter
24” Concrete Roll Curb and Gutter
18” Concrete Vertical Curb & Gutter
24” Concrete Vertical Curb & Gutter
Valley Gutter
Cost Data, Roadway:
Right-of-Way Costs (Cost of Land Only) $
Construction Costs (Roadway Construction Only) $
Paid by
GL Account No. (City Use Only) #
Infrastructure Survey – Roadways
City of Charleston, South Carolina
ISR1-2015 Page 2 of 2
Cost Data, Sidewalk:
Cost of Construction (For Sidewalks Only) $
Paid by
GL Account No. (City Use Only) #
Cost Data, Curb, Curb and Gutter:
Cost of Construction (For Curb, Curb and Gutter Only) $
Paid by
GL Account No. (City Use Only) #
Developer Certification:
Name of Developer:
Developer’s Address:
Developer’s Authorized Signature:
Engineer Certification:
Name of Engineer of Record:
Engineer’s Address:
Engineer’s Authorized Signature:
For City Use Only:
City Council District Number:
Political Jurisdiction
City County State
Maintenance Jurisdiction
City County State
Review by Finance By: Date:
Date of Acceptance/Dedication by City Council: Date:
Forwarded to Finance Date:
Forwarded to Charleston County Date:
Forwarded to Gis Date: