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270551 site plan.pdf�. -,tJT Drop Bury#1:j 38gq CSG Drop suryN: Date j� /11 / 1�I Nade: M _ fury Drop Form 7 Customer Name: Lk5A Phone# :� $� -?�i/( DZ Address;?_310C _15 �1 ty4r' W City. nt ZIp:Q Cross S#reet; 3.0 Ytk W ❑Service Effecting &Out of Service ❑Pending install ❑Temped Tech€t : 7. Tech Cell: 421�' 039� Priority Level: 01-Commercial 2-New Cust /Svc Drop Impaire..d /can't Temp ❑3-Svc Drop Impaired / Can Temp Type of Bury: STH Footage ROW Footage Permit Aeclulred Y N Bark Yard.Fasement:Y❑N Sidewalk Bore Planting Strip: Y❑,N Sprinkler System: Y❑ N Driveway sore Sidewalk- Y❑ N® :Septic Field: Y❑ N Landscape sore Road Edge: Y❑ NII Dralh Pipe: YH NN Road Bore Curb: _ Y❑ N® Private Water: Y❑ N.� Soft Surface 5 ' Hard Surface Total:111) Private Wiring: Y❑ NR Total: Sv Total: Total Bury: JS). What..Kind? customer Home For Bury: Y❑ N❑ Call Customer First. Y❑ N❑ Best i1 For Customer:. Comments, "�,>ti 1 P 0 R. LA Existing conduit: Y /0 Existing Conduit Location: STH / ROW Existing:Condult Length: Ft. CUSTOMER CONTACTED AND REVIEWED OF NEW DROP Y❑ NOT HOME, LEFT DOOR TAG Y,N Being the owner of the above property, l.hereby give my permission to Comcast, or their duly authorized representative to bury a service line on my property, Property Owner's Signature: TV- Existing Carson. Plate Carson - &' sewer- ` Polo - pi,=3 - ❑ Street Light - Power - Catch gaslii ® Gas - Fronfier - Fire HydranE - Water1irrigetlon A mali Uox- Si�ow Center Lute to: Cuii� Sidevlalk Ped t rC. Sho1v Sensittve Area's: wetlands Creeks ©ar ditch HI h Paint Low Potnt ETC ES r QTY ACT Q'1^l 1TEYiS CST QTY ACT `CY 1I'CMS 1ST Qf Y ACT QTY >vl.ATI_S EST TY ACT QTY tiiATLS av 73 Cf� Cc/. '70 UN Z I 159 r i f f J 1 r i Z S ti bb I/ fs" VJ