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Work Activity Work Order Pa9e 1 <br /> s/v/zoia ir.�s <br /> ISSU2d By GCR GRENZNER,CHRIS R. <br /> Issued Department Pw PUBLIC WORKS <br /> Date Issued verzo�a <br /> Fund aot Account s Program �to Function �oe Activity s�s <br /> Program <br /> TIIIB REPAIR 4216 TERRACE DR 770109675 <br /> Work Order No 20140171 Project Aciivity Type SERVICE RE�UEST Status c� <br /> Status varzo�a Time itao Ori inalWO Billing __ <br /> --9--— -- - -- - _ <br /> Customer Infonnation <br /> Customer Name MARK DOUCETTE Cusiomer ld <br /> Address Street <br /> ApaKment No City <br /> State Z�P <br /> Subdivision Change Map Y/N <br /> Phone No ( 1 - Ext <br /> Second °hone ( ) - Ext <br /> E-G9ail Address <br /> Problem Information <br /> Address 4216 Street TERRACE DR <br /> From Cross Street <br /> To Cross Street <br /> City Zip <br /> Subdivision Map Book Map Reference <br /> Problem SEWER SEWER <br /> Sub Problem SS SIDE SEWER <br /> Requested By oM� �oucerre,t,�nRK e. Date Requested tononoi3 <br /> Agency Related Request aotzazee <br /> I�itialed From INTER INTERNAL <br /> Utility Locate (USA) No 13327880 Called Date Expiration Date <br /> Assic�nment Information <br /> Oept �'w PUBLIC WORKS Priority Estimated Hours <br /> Cr2w SCONST SEVJER CONSTRUCTION(GRENZNER) <br /> Contractor <br /> ASSigned TO OBS OLHAVA,BRAD S. <br /> Assigned By GCR GREN2NER,CHRIS R. <br /> Assigned Date _ To Be Comp Date I <br /> Schedulad Date Scheduled Time <br /> Roule Route Sequence <br /> Comments <br /> Action Taken REPLACED SIDE SEWER FROM BACKWATER VALVE TO MAIN. <br /> Reconimended Action �EpqiR sioe sewert <br /> Approved By oss OLHA�A,BRAD S. Jn! Cost Information(YIN) <br /> Start Date � � Time Date Completed tis�2o�a ___ _ Permit No _ <br /> Ccmpleled Dy Time Follow Up? _ _ _ <br />