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266552 site plan.pdf�i tcaSt�T Drop Burytt:65'751� CSG Drop Burytt: Date t 1 / i / 1-7Node:VAc d Bury Drop Form Customer Name: Phone# : I`L )Oq $ Address: W1 $ SI'ri{ PL tJ City: 6b MbtJM zlp: J�Ox4 Cross Street: U tit tt:"iA1 lL ❑Service Effecting ❑out of Serv€ce igPending Install ❑Temped Tech0 :'W03L Tech Cell: q7.5'- 237 03Z Priority Level: ❑l-Commercial 2 New Cust /Svc Drop Impaired /Can't Ternp 03-Svc Drop impaired / Can Temp Type of Bury; STH Footage ROW Footage Permit Required: Y N❑ Back Yard Easement: Y❑N® Sidewalk Bore Planting Strip: V❑ NM Sprinkler System: Y[-1 N® Driveway Bore Sidewalk: YN N❑ Septic Field: Y❑ NM Landscape Bore Road Edge: YM N Drain Pipe: Y N� Road Sore Z Curb: YVJ N❑ Private Water: Yo NIZ Soft Surface Hard Surface Total'. :Zj Private Wiring: Y❑ N® What Kind? Total:3q' Total: �j5~' Total Bury: $ Customer Home For Bury., YE] N❑ Call Customer First; Y❑ N❑ Best It For Customer: Co meats L 211 C t C.POLE-- `"' %plyffE1 or 5 LAC 'at-� t="N -3 C' f L N\ b ROJ2Z RN1 hi CI` +�/� i2;xeta kt,I r.J v.! F a ov RoAb Existing Conduit: Y /4D Existing Conduit Location: STH / ROW Existing Conduit Length: Ft. 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 Conicast, or their duly authorized representative to bury a service line on my property, Property Owner's Signature: Leeend TV- Existing Carson Plata Carson - A Sewer • • Poie - Phone - ❑ Street Light - 0 Power - Catch Basin - - Gas - � Frontier- Ftro Hydrant Wator/irrigation - A Mail Box- show Center Line to:.CurEi Sidewalk Ped ETC, Show Sensitive Area's: wotiands, Creeks, Bar Ditch, HIE;11 Point, Law Mrt,_e t c ITEMS ES'r QTY ACT QTY I ITEMS EST QTY ACTT QTY i4IAATLS EST QTY ACT QTY tolkTLS EST QTY ACT QTY n, % I -XII CI G Sbt U.2. I I ko Cmes ©N f a`i 1-1 3 y Ctc D-0 C `