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ISSUBd BY � AGA <br />Issued Department Pw <br />Date Issued tvsizot� <br />Fund ao� <br />Program <br />NO MATE�IqLs <br />Work Activity Work Order Pace � <br />izne/2oii e:�+3 <br />AHLES, GREGORY A. <br />PUBLIC WORKS <br />Account s Program »o Func[ion �p3 Activity s�t <br />TIll2 ADJUST 4412 S 3RD AVE 770723677 <br />Work Order No 20112581 PfOfOCI Activit�� Type CORRECTIVE MAINTENANCE $I8IU5 CL <br />Status �v�rzo� i Time o� os Original W0_ _ _ _ _ _ _ _Billing _ _ _ _ _ _ _ _ __ _ <br />Customer Information <br />Customer Name Customer ld <br />Address aatt SIf22I S 7RD AVE <br />Apartmenl No �ity <br />State Z�p <br />Subdivision <br />Phone No ( ) - Ext <br />Second Phone ( ) - Ext <br />E-Mail Address <br />Problem Informalion <br />Address qq�y Street S3RDAVE <br />From Cross Street <br />To Cross Street <br />City ZiP <br />Subdivision Map Book <br />Problem ORAIN DRAINAGE <br />SubProblem F8G FRAMEANDGRATES <br />Requesteo By OBM1 DOOIAN, BRIAN td <br />Agency <br />Initiated From <br />Utility Locate (USA) No Called Date <br />Assignment Information <br />Dept Pw PUBLIC WORKS PflOfi[y <br />CfeW SCONST SEWER CONSTRUCTION (AHLES) <br />Contractor <br />Assigned To OBS OLHAVA, BRAD S. <br />Assigned By AGA AHLES. GREGORY A. <br />Assigned Date To Be Comp Date <br />Scheduled Date _ Scheduled Time <br />Route Route Sequence <br />Comments <br />Action Taken RpISEO FRAME AND GRATE THAT WAS OVERLAYED TO SURFACE. <br />Change Map Y/N <br />Map Reference <br />Date Requested <br />Related Request <br />Expiration Date <br />Estimated Hours <br />RCCOf11f11011dCd ACtIOtl RAISE CB TO STREET LEVEL <br />4pproved By oes o�Hnvn, Bano s. Job Cost Information(YIN) <br />Start Date � i Time Date Completed tznano�t _ <br />Completed By Time Follow Up? _ __ <br />Permit No <br />�Z <br />