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PERMIT FIELD Cl-MCK]L,IST <br />PM#4607;%OO USA# .SUBMITTED BY: MRDE. DATE: I2I13/iZI <br />PERMIT FOR: 3700 5ectioY` Ave. 5toaktoh <br />NBC G 0 (or) E 0 EMERG ❑ LK J< (GRADE): 2- GPRP 0 CPRP 0 <br />IF EMERGENCY, IS WORK COMPLETED ALREADY? YES 0 NO 0 (DATE)? <br />SCHEDULED DATE: <br />DATE PERMIT REQUIRED: <br />• AGENCY (CITY, COUNTY, CALTRANS, OTHER):O.fip_ <br />• VERBAL AUTHORIZATION OBTAINED: YES 0 NO 0 •7 <br />• (DATE/TIME/CONTACT)? <br />• LOCATION (INCLUDE DIMENSIONS FROM PROPERTY LINE, NEAREST CROSS STREET, CURB OR LANDMARKS) <br />• DIMENSIONS FOR EXCAVATION (W x L x D): q X4x 4 <br />• ASPHALT 9 CONCRETE 0 BOTH 0 NO PAVING 0 <br />• DIMENSIONS FOR RESTORATION (IF ASPHALT, INCLUDE ADDITIONAL FOOTAGE FOR "T" TRENCH OR OVERLAY. <br />IF CONCRETE SIDEWALK, INCLUDE FOOTAGE FOR ENTIRE FLAG OR NEAREST JOINT) N/A <br />• SIDEWALK CLOSURE REQUIRED? YES 0 NO X <br />• BIKE LANE CLOSURE REQUIRED? YES 0 NO 2 <br />• STREET CLOSURE REQUIRED? YES 0 NO M <br />• LANE CLOSURE REQUIRED? YES NO El <br />• PARKING CLOSURE REQUIRED? YES 0 NO <br />• OTHER TRAFFIC IMPACTS? <br />• ANY RESTRIPING REQUIRED? YES 0 NO 12 <br />• TRAFFIC SIGNAL LOOP INVOLVED? YES NO® <br />• WILL "NO PARKING" SIGNS BE NEEDED? YES 0 NO R <br />• OTHER COMMENTS TO FACILITATE PERMIT REQUEST? <br />.. _ AA - <br />V) <br />