269960 site plan.pdfOMC(]St)T Drop BuryH: 6 Zoi. CSG Drop Burytl: Date 1z / 15 / 17 Node:t�Alt- Bury Drop corm
Customer Name: NQt 0Ct40Phoned:qZ,�— 264
Address: [Itq r -R City: amaob5 Zip:q'K07.0 Cross Street:
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❑Serv€ce Effecting ❑Out of Service ❑Pending Install I,Temped Techil : 0'0'3Z. Tech Cell: w rvssr
Priority Level: ❑1-Commercial ❑2-New Cust /Svc Drop Impaired /Can't Temp R13-Svc Drop Impaired / Can Temp
Type of Bury;
STH Footage
ROW Footage❑i�
Permit Rectulred: YN NE]
Back Yard Easement: Y
Sidewalk Bore
Planting Strip: Y❑ NX
Sprinkler System:
Y❑ Nf9
Driveway Bore
I Sidewalk: Y❑ N.®
Septic Field:
Y❑ NS.
Landscape Bore
—][Road::Edge:
Y❑ N[
I oraln Pipe:
Y❑ NEI
Road Bore
Curb: Y N[g
I Private Water:
Y❑ NE,
Soft surface.
'Si `
Hard Surface Total: l�
Private Wiring:
What Kind?
Y❑NQ
Total: 51 t
Total: °LU'
Total Bury; i i'
Customer Home For Bury: Y❑ N❑ Call Customer First: Y❑ N❑ Best H For Customer:
Comments A tIY�� V" LIz l �. 1, LA ``"" f `?
Existing Conduit:(Sfj/'N Existing Conduit Location ST /ROW Existing Conduit Length: Ft.
CUSTOMER CONTACTED AND REVIEWED ROUTING OF NEW DROP Y❑
NOT HOME, LEFT DOOR TAG
YM
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:.
Leeend
TV
Existing C8r5011
Place Carson -
sewer °
Pole - 0
Phone - ❑
Street Light - 0
Power - N
Catch Basin - U0
Gas-Q
Frontier-
fire Hydrant -
Water/irrigatlon - A
Mail ook -
Show Center tine to: Curb. Sldawalk. Ped. ETC. Show Sensitive Area's! wetlands. Creeks. Bar Ditch. lileh Point. Low Paint, ETC
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ACT QTY
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