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Work Activity Wark Order Page 1 <br /> ��i5��ois 8:5� <br /> Issued By oos OLHAVA,ew�o s. <br /> Issued Departmentaw PUBLICWOi2KS <br /> Date Issued ai�no�s <br /> Fund ao� Account 5 Program ��o Function �oe Activdy s�s <br /> Program <br /> Titl2 REPAIR 11420 23RD DR SE 710109675 <br /> Work Order No 20150863 Project Activiry Type SERVICE REDUEST Status c� <br /> 3tatus ai3izois Time �5 �3 Original WO _ Billing _ <br /> Customer Information <br /> Customer Name SOMERS,BRIAN Customer ld <br /> Address Street <br /> Apartment No City <br /> State Z�p <br /> Subdivision Change Map YIN <br /> Phone No ( a25 ) no•ss�+ Ext _ ___ _ <br /> Second Phone c ) - Ext <br /> E-Mail Address _ - <br /> Problem Information <br /> Address ��qZp Street 23RD DR SE <br /> From Cross Street <br /> To Cross Street <br /> City Zip <br /> Subdivision Map Bnok Map ReFerence <br /> Problem SEWER SEWER <br /> Sub Problem SS SIDE SEWER <br /> Requested By MCL1 MALLAND,CHAD L R@Ia1Bd R2GU85f �0197557 <br /> Agency <br /> Initialed From PUBLIC PU6LIC <br /> Utility Locate (USA) No Called Date Expiration Date <br /> Assignment Information <br /> Dept PW PUBLIC WORKS Pnority Estimated Hours <br /> CfeW VACN VACTORlTV CREW(GRENZNER) <br /> Contractor <br /> Assigned To PWR PUGSLEY,NlILLIAM R <br /> Assigned By oes ouinvn,aw+o S. <br /> Assigned Uate To Be Comp Date <br /> Schedulea uate Scheduled Time <br /> Route Route Sequence <br /> Comments <br /> Action Taken REMOVED STAND PIPE FOR CLEANOUT,REPLACED CRACKED 45 E11 @ Y.BACKFILLED, <br /> COMPACTED,TOPSOIL TO GRADE. PLACED METAL ON CLEANOUTCAP. <br /> Recommended Action REPAIR BROKEN WYE <br /> Approved By IJM IIdHOF,JAMES M JOb COSt IflfOffnOtion(YIN) _ <br /> Start Date i i Time _ Date Completed 511 612 0 1 5 Permit No _ <br /> Completed By Time Follow Up? <br />