257701 site plan.pdf5G Drop #: Date�Y7 Node:�� BuryDMP F(JYM
Lomcust CSG Lucate�: �J i � Bur Y
�. Phone#
CustomerN'afine: �1 �1
Address: DE �Dp� Lf A a lie �Y pity: �. (�I r
zip: _ 90ak Cross Street:
oService T ffecting ❑0ui ofServfce '®Pending Install []Temped Tech#.8C10r7.
Tech Celt:
Priority Level: ❑1-Commercial 2-New Cust /Svc Drop Impalred/Can'tTernp E13-Svc Drop impaired /Can Temp
Type of Bury: STH Footage ROW Footage Permit Required: Y N❑ Backyard basement: Y]N®
kl 5 stem, Y0 NO
Sidewalk Bore
Planting Strip: YQ N
YQ
Sprin er y .
Sepfiic Field;
Y[] N
➢riveway Bate
Landscape
Sidewalk:
Road Edge: Y� NE]
Drain Pipe:
YQ N❑
Y[]
Bare
Curb: YEI N®
Private Water:
Road Dore
r
Hard Surface Total: a',i
Private Wiring:
y0 NX
Soft Surface (3
Tata1;
i'rs
6 ` Total: /
Total Bury: (. � t
What Kind?
$
Customer Home For Bury: YE] NN
Call Customer First: YK N❑
Best # Far Customer:
o
Comments Ica bl r• �nivvr (y'I! ron►
e f f1
G n >y
War'
CUSTOMER CONTACTED AND REVIEWED ROUT
ING OF NEW DROP Y[] NOT HOME, LEFT DOC)R TAG Y�
Being the owner of the above property, I hereby give my permission to Comcast, ar the€r duly authorized representative
to bury a service line on my property. Property Owner's Signature:
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TV • Fkisting Carson - Sewer - Pole - Phone -
Street light ^
Place Carson - Mail Bpx ^
_ r 1 Frouilcr I Fire Hydrant-0 water/1ttigatinn-
711th o,r�
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