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NOTE
Permit required do not start
wcrk until permit is received
' STATE HY.
VILLAGE
CITY ff�A4� t-
COUNTY
N3J03D,kI Mop 1 B - I E
NOT FOR DISCLOSURE OUTSIDE NWB TEL CO EXCEPT BY WRITTEN AGREEMENT
Permits Required
�.t MEL
Record Print. R/Z
-¢/ J300
Serv. Date
6 —2'3 - B8
C/Z
Comp. Oats
6 --Z9- 36
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Yes
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Town or W r linter
1ilMEL
Taper Codesr// � nv.,?
Q No
Phone #
5�9 - 3d48
Tracer
/4Ms
Piecing Cable 30,E
Wire
Depth Other
Conformance Test.
Yes
CEED
JO/Est /
2 LL 75-
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