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262452 site plan.pdf
0M(:jSt CSG Located;, . a ` CSG prop Bury)f: [date 53(3Node: C Bury Drop Form Customer Name: Phoneff :��q-?2 v %2 Address: ��.tt�vv. irV City;€p:�C1�� Cross Street: Service Effecting []Out of Service Pending Install ❑Temped TechH : Tech Cell: Priority Level: ❑i-Commercial 2-New Cust /Svc prop Impaired /Can't Ternp ❑3-Svc prop Impaired / Can Temp Type of Bury: STH Footage ROW Footage Permit Required: YKj No I Back Yard Easement: Y❑N❑ Sidewalk Bore Planting Strip: YE N❑I Sprink€er System: Y© N❑ Driveway Bore j} Sidewalk: Y❑ N© I Septic Field: YL] N Landscape Bore Road Edge: Y-- N© Drain Pipe: Y N.❑ Road Bore Curb: Y N Private Water: Y❑ N Soft Surface Hard Surface Total: private Wiring: Y❑ NQ What Kind? Total: Total: [; Total Bury: 1761 Customer Home For Bury: Y[2C N❑ Call Customer First; Yo N❑ Best It For Customer: - Comments " CUSTOMER CONTACTED AND REVIEWED ROUTING OF NEW DROP Y❑ NOT HOME, LEFT DOOR TAG Y❑ Being the owner of the above property, I hereby give my permission to Comcast, or their duly authorized representative to bury a service line on my property. Property Owner's Signature: �pnpnn TV. Existing Carson place Carson - Sewer - • Pole - phone - El Street tight • 0 Power - Catch Basin - Gas - Frontler Pre Hydrant - Water/irrigation - A Mall Box - Vim 6�1