HomeMy WebLinkAboutP_Pre-Inspect_887034321_V1_171121bb -7 0rD*-szk
..,risdiction: r1
i
Right of Way Permit? &KYES ❑ No
First Poss Start:
First Poss Comp:
Plat Map:7_,e 4 p g
PRE -INSPECTION REPORT
Address:
City / Zip:
Customer:
PM / Insp� ,`
Est Duration:
N
&. /'I W_ of CL
10 W64 I SOUNP MERCY
AV A)(�'
-' QSTEHURENUvfNM�--
INSP PHONE NUMBER
Size of Cut.
New Constru
❑ YES [�
L �P
—
of CL
IAll= to �'F
of CL
CL
-
of CL
El
FLAGGERS #
g"gip #'
MPH
❑ oF�tl—
❑
SPEED LIMIT
Q Commercial
❑
Altered Commercial
Residential
❑ Multl-Family
❑ New constr.
❑ Stub
❑
❑
❑
❑
Altered Residential
Replacement Service
Main Maintenance
Service Maintenance
Extension
❑ Compete Sery
❑
❑
Valve Maintenance
Cut & Cap
Pipe S t z e
Meter
FFV
❑ 1800
PRE -INSPECTION REPORT
Address:
City / Zip:
Customer:
PM / Insp� ,`
Est Duration:
N
&. /'I W_ of CL
10 W64 I SOUNP MERCY
AV A)(�'
-' QSTEHURENUvfNM�--
INSP PHONE NUMBER
Size of Cut.
New Constru
❑ YES [�
L �P
—
of CL
CL
-
El
TRoCLTTms ❑
g"gip #'
ff
❑
UA99--KL
❑ NO -PAWS-#
Leak Repair
--------------
S e r V I c e I n f o r m' a t i o n
❑ Template Bar
❑
El
CP Work
Pothole
Pipe S t z e
Meter
FFV
❑ 1800
'
❑ Bollards 2,5" # C
U
Extension
❑ 1/2" Q
21/411 ❑❑ 425
❑ 2600
❑ Bollards 4" #
n 3/4"
❑ 630
❑ 10,000
❑ Fuel Line Permit Needed
❑ 11/8''
Q 1000
Fuel Line Length:
Mtr Loc;
Fuel Line Diameter: