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Work Activity Work Order Pd�e ' <br /> �/?/zois �s: �e <br /> ISSU@d By SJT2 SPOONER,JAMES T. <br /> Issued Departmentaw PUBLICWORKS <br /> Date Issued snn2ots <br /> Fund aoi Account s Program Function Activity <br /> Program UT3473 6 3 <br /> TIII2 CONVtRT ]51NCH 19G1 LOMBARD AVE 1iT3473-6-3 <br /> WOlk O�dBf NO 20151193 PfOJ2Ct ACliViy Typ2 CORRECTNE�dAINTENANCE St2tU5 CL <br /> Status sm�zois Time osn Original WO Billing <br /> Customer Informalion <br /> Customar Name Customer I� <br /> Address Street <br /> Apartment No City <br /> State Zip <br /> Subdivision Change Map Y/N <br /> Phone No ( ) - Ext <br /> Second Phone l 1 - Ext — - <br /> E-Mail Address <br /> Problem Information <br /> Address 180i Street LOMBARD AVE <br /> From Cross Street <br /> To Crass Street <br /> Clly Zlp <br /> Subdrvision Map Book Map Reference <br /> Problem WATER WATER <br /> Sub Problem OTHER OTH[R <br /> Requested By Date Requested <br /> Agency Related Request <br /> Initiated From <br /> Utility Locate (USA) No Called Date Expiration Date <br /> Assignment Information <br /> Dept Prioriry Estimated Hours <br /> Crew <br /> Contractor <br /> Assigned To <br /> Assigned By <br /> Assigned Date ___ To Be Comp Date _ _ f� <br /> Scheduled Date Scheduled Time ����Uv!�1��� �,�� � <br /> Route Route Sequence <br /> —-- �'' <br /> Comments <br /> Acti�n Taken CONVERT.751NCH CURBSTOP T0.751NCH SETTER WITH METER AND BOX.FLAT TO METER <br /> PROJECT. ' <br /> Recommended Action <br /> Approved 8y HLJ HUSBY, LANCE J JOb COSt IflfOfrt12tl0fl(Y/N) <br /> Start Date i i Time Date Completed sn�izots Permit No <br /> Completed By • Time � Follow Up? <br />