Laserfiche WebLink
450(o PERM17 FILELD CFECKLIST <br />PM�USA# SUBMITTED BY: �� DATE: <br />PERMIT FOR: <br />NB O G O (or) E O EMERG ElU(4(GRADE): 3 GPRP Cl CPRP O <br />IF EMERGENCY, 15 WORK COMPLETED ALREADY? YES ❑ NO Cl (DATE)? <br />SCHEDULED DATE: <br />DATE PERMIT REQUIRED: <br />• AGENCY CI COUNTY, CALTRANS, OTHER):AL440,fl <br />• VERBAL AUTHORIZATION OBTAINED: YES O NO O� <br />• (DATE/TIME/CONTACT)? <br />• LOCATION (INCLUDE DIMENSIONS FROM PROPERTY LINE, N�AREST CROSS STREET, CURB OR LANDMARKS) <br />• DIMENSIONS FOR EXCAVATION (W x L x D): 4 X <br />• ASPHALT XCONCRETE ❑ BOTH O NO PAVING ❑ <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 O NOZf� <br />• BIKE LANE CLOSURE REQUIRED? YES O NO IT-- <br />• STREET CLOSURE REQUIRED? <br />YES ❑ NO z' <br />• LANE CLOSURE REQUIRED? <br />YESXNO O <br />• PARKING CLOSURE REQUIRED? <br />YES O NO 0-- <br />• OTHER TRAFFIC IMPACTS? <br />• ANY RESTRIPING REQUIRED? <br />YES O NO ET--/ <br />• TRAFFIC SIGNAL LOOP INVOLVED? YES O NO 9 <br />• WILL "NO PARKING" SIGNS BE NEEDED? <br />YES O NO P� <br />U <br />