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N�ork Activity 1�Vork nrder PaS� ' <br /> 12/1�/2015 9:36 <br /> Issued By CSG CAVANAH,SHANE G. <br /> Issued Depariment Pw PUBLIC WORKS <br /> Date Issued 9117I2015 <br /> Fund ao� Account 5 Program ��o Function »y Activity 6�5 <br /> Program <br /> TIfIE REPIACE .75 IhCH 4532 EVERGREEN WAY 710119675 <br /> Work Or�er No 20152073 PfOfBCl Activiry Type CORRECTIVE MAINTENANCE $I2llJ5 Cl <br /> Status e�mzots Tirre tz.00 Original WO zo�siste Billing <br /> Customer Information <br /> C�stomer Name Customer ld <br /> Address Street <br /> Apartment No City <br /> State Zip <br /> Subdivision Change Map Y/N <br /> Phone No ( ) • Ext <br /> Second Phone ( ) • Ext ---- <br /> E-Mail Address <br /> Problem Information -- <br /> Address Street <br /> From Cross Street <br /> To Cross Street <br /> City Zip <br /> Subdi✓ision Map Book Map Re(erence <br /> Probiem <br /> Sub Problem <br /> Requested By Date Reque-'ed <br /> Agency Related Request <br /> Initiated From <br /> Ulility Locate(USA) No Called Date Expiration Date <br /> Assignment Information <br /> Dept Priority Estimated Hours <br /> Crew <br /> Contraclor <br /> Assigned To � <br /> Assigned By <br /> Assigned Date To Be Comp Date <br /> Scheduled Date� Scheduled Time <br /> Route Route Sequence <br /> Comments <br /> Action Taken RENEWED.751NCH POLY AND CONNECTED TO NEW 8"MAIN WITH NEW SETTER AND BOX <br /> Recommended Action <br /> Approved By RJP �PELYEA,JASON P. ,lob Cost Information(Y/N) <br /> Start Date i � Time Date Ccmpleted 9n�nois Permit No <br /> Completed By Time Follow Up? <br />