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1Nork Activity WQrk Order ra�` 1 <br />�z�i�z�„ ia:» <br />ISSUBd BY CSG � CPVANAH, SH.>NE G. <br />Issued DepaRment Pw PUBLIC WORKS <br />Date Issued tvyzo�t <br />Fund aoi Account s Program ��o Function t�s Activity s�s <br />Program <br />Title REPAIR .75 INCH 2517 LEXINGTON AVE 710119675 <br />Work Order No 20112472 i�fOJCC� Activity Type CORRECTIVE MAINTENANCE St8fU5 CL <br />Status ivsizoii Tirneoro� OriginalWO __ 6illing <br />Gustomer Information <br />Customer Name Customer ld <br />Address Street <br />Apartment No City <br />State Z�P <br />Subdivision Change Map Y/N <br />Phone No ( 1 - Ext _ _ _ <br />Second Phone ( 1 • Ext <br />E-Mail Address _ <br />Problem Information <br />Address Street <br />From Cross Street <br />To Cross Street <br />City ziP <br />Subdivision Map Book Map Reference <br />Problem <br />Sub Problem <br />Re uested B Date Requested <br />Agency y RPlated Request <br />Initiated From <br />Utility Locate (USA) No Called Date Expiration Date <br />Assignment Informa!ion <br />Dept Priority Est�mated Hours <br />C rew <br />Contractor <br />F,ssigned To <br /><�ssigned By <br />A_signed Date T� Be Comp Uate <br />Scheduled Date Scheduled Time <br />Route Route Sequence <br />Comments <br />Ar.tion Taken INSTALLED SETTER AND JUMPER. SERVICE IS 7 FEET LEFT OF RIGHT. 1J FEET OUT. <br />Recommended Action <br />�\pplOV2d By BGM2 BEUKERS, GEORGE M. .lOb COSI IflfOffT18fI0f1(Y/N} _ _ <br />5;art Date , � Time _ __ Data Completed �v3�zot�__ _ Permit No _ <br />Completed By Time Follow Up? __ _. ___ <br />