257905 site plan.pdf('C®MCastJT Drop Bury#:4S-t 350 CSG Drop Bury#: Date /0/91 / 1Node: 41 Bury Drop Form
Customer Namelips Lvwts Phone9:1-lZS'`7`7)
'5q)3
Address., '32,1 S C City: 6bM4p Zip: 1702o Cross street: qq v�
[Service Effecting ❑Out of Service ending Install ❑Temped Tech# : S03 x- Tech Cell: 4 z 5 7-.3'9
0394
Priority Level: []1-Commerclal N2-New Cust /Svc Drop impaired /Can't Temp ❑3-Svc Drop Impaired / Can Temp
Type of Bury:
STH Footage
ROW Footage
Permit Required: Y N❑ Back Yard Easement: Y�N
Sidewalk Bores
Planting Strip: Y❑ NE I Sprinkler System:
Y❑
Driveway Bore
Zvi
Sidewalk: YM N❑ Septic Field:
YLI
Landscape Bore
Road Edge: Y0 ] Drain Pipe:
YQ €
KJ
Road Bore
Curb: YD N® Private Water:
Y❑ N
Soft surface
31 i
Hard Surface Total: `Zo ` Private Wiring:
Total Bury: 10Z' What Kind?
Y❑ NE
Total:51
I Total:51'
Customer Home For Bury: Y❑ N❑ Call Customer First: YEI No Best # For Customer:
Comments S " Cie YtsJM At G CI�t�S roe-)J -r Ct
S-, ,
Existing Conduit: Y N Existing Conduit Location: STH / ROW Existing Conduit Length: Ft.
CUSTOMER CONTACTED AND REVIEWED ROUTING OF NEW DROP Y•k;
NOT HOME, LEFT DOOR TAG
YQ
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:
eeenu
TV- W
place [arson -
sewer '
I Pole - 0
1 Phone - ❑
Street Light - Q
Power-M
Catch Basin -
Gas - [+
Frontier-tJ
Fire Hydrant-
water/irrigation - A
Mall Box -
Show Center
Line to: Curti
Sidewalk
Ped ETC.
Show Sensitive
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