260433 site plan.pdfCq6mcast CSG Locate#: Zz CSG Drop Bury4: Date ZZ j7 Node: Bury Drop Form
Customer Name:
'SLtS
`H
Address: ' o q City: Zip.1702 S Cross Street:
❑Service Effecting ❑out f Service Pending Install ❑Terriped Tech# :1-616 1 Tech Cell: i Z <" 7S-°j-ZHi9
Prlority Level: ❑1-Commercial 27New Cust /Svc Drop Impaired /Can't Temp ❑3-Svc Drop Impaired / Can Temp
Type of Bury:
STH Footage
ROW Footage
Permit Required: YM
N❑
I [tack Yard Easement., Y❑N
Sidewalk Bare
Punting Strip: Y❑
N
Sprinkler System: YN
N❑
Driveway Bore
Sidewalk: Y❑
N
Septic Field: YEI
NO
Landscape Bore
Road Edge: Y❑
Ng
Drain Pipe: YN
N
Road Bore ZIS Curb: Y❑ NN Private Water: Y❑ N
Soft SurFace !'ZD' ' iZ. Hard Surface Total,. US' Private Wiring: Y❑ N[N
Total: I7_0 ' Total: ji Total Bury: 23-7 What Kind?
Customer. Home For Bury: Y❑ N Call Customer First: Y® N[] Best 11 For Customer: 5
Comments M.,. '74 a'i rew. dl Gr
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:
Leizend
TV- ®
Existing Carson • Place Carson -
Sewer
Pole • 0
phone. ❑
Street Eight - O
Power-M
Catch Basin - Gas - 0
Frontier • d j
Fire Hydrant-
Water/Irrigation-A
Mail Box -
snow center
Gina ta: t:u_rb,
Sidewalk.
Pec4, ETC. Show Sensitive
Area's; Wetlands Creeks
aar Ditch High Point Low point ETC
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