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263024 site plan.pdfCOMCCISt)T Drop Bury# (ZS' CSG Drop Bury#: Date 6 �l Node: e-Bury Drop Form Customer Name: � I ; tie, Phoned: Lf 2-SS-77 S`$lyj 1 Address:2 o 043 V o t h I city;15D kno,12-S -ISo"2, b zip: Cross Street: ❑Service Effecting ❑Out of Service ❑Pending Install ®Temped Techd : Tech Cell :q 2.�,_ ? Ty_ Q jQ j Priority Level; Ell -Commercial ❑2-New Cust /Svc Drop impaired /Can't Temp 3-Svc Drop Impaired / Can Temp Type of Bury. STH Footage ROW Footage Permit Required: YM N Back Yard Easement: Y❑N Sidewalk Bore Driveway Bore 2 Planting Strip: Y❑ N© Sidewalk. Y NW Sprinkler System: Y❑ N Septic Field: Y❑ N Landscape Bore Road Bore 2 Z Curb: Road Edge: W7Wh e: Y❑ N ater: Y❑ N Soft Surface li [' 9 Hard Surface Totiring; Y❑ No Total: L-i- Total: 23 � Total Bury: 2d? Customer Home For Bury: Y❑ N® Call Customer First: Y66 N❑ Best it For Customer: SOL, Comments tt w. A ---An. (n t mow. Once, 2 le Existing Conduit: Y/A Exlsting Conduit Location; STH / ROW Existing Conduit length: Ft. CUSTOMER CONTACTED AND REVIEWED ROUTING OF NEW DROP Y[@ NOT HOME, LEFT DUOR TAG Y❑ Being the owner of the above property, I hereby give my permission to C mcast, it duly authorized representative to bury a service line on my property. Property Owner's Signature: TV - on - �C#11Cb,1sn Place Carson - Q Sewer - •�Flreydmnt Phone - ❑ Street light - 0 Power - • Q Frontler - .Gas-waterArrigation- A Marf Box- ShnW (petlarlFnn rm fi.rk c1.E...,...11, .-A err ..--- ----- - -.--.� �.��,•«• �W �.�. �,i�w�en>icaxervea's;we[laisil5 creeKS bar vitcli Fil tlPnint Low Point EY lTE1 lS EST TY ACT TY ITEMS EST QTY ACT QT Y NIATLS EST QTY ACT TY MATLS EST QTY �ICT QTY u.q ys