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Expense Job -Site Information (for non-estimated work) <br />PM #--=l?.Sy 'B lU _ <br />Name &Lan ID:G-l<!S jlez Cllde.nJos C ""V7 <br />Address:"10 J..p,Lo reD.;tJ e. <br />City or County name:~7J~~-()~c---.1------_ <br />CPA:.5 I 71-1 _ <br />CPA map attached?0 YES 0 NO <br />Description of work needed:I tvS 10-11 .5 -?J,.tb 0.NC)C/eS Q TV G-A-S Ma..:1\) <br />'bl if'x8'[le,/(hole @.C]o2,B {orffijn€ <br />Work location Sketch <br />t <br />('0 <br />Excavation location Sketch Requirements: <br />1,Provide dimension from cross streetl and cross street 2 <br />2.Dimension should reference as back of walk,edge of pavement or center line <br />3.Indicate North Arrow <br />1(\1,"'I <br />-.----l' <br />I <br />I