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PERMIT FIELD CHECKLIST <br />PMN qLA5Wn7n USAN <br />PERMIT FOR: <br />BY: IV PDL DATE: 9/17/24 <br />NB 0 G 0 (or) E 0 EMERG 0 LK Od (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: Ip/I-7/21 <br />• AGENCY (CITY, COUNTY, CALTRANS, OTHER): !66L1 ,'og <br />• VERBAL AUTHORIZATION OBTAINED: VES 0 NO 0 _ V <br />• (DATE/TIME/CONTACT)? <br />• LOCATION (INCLUDE DIMENSIONS FROM PROPERTY LINE NEAREST CROSS STREET, CURB OR LANDMARKS) <br />• DIMENSIONS FOR EXCAVATION (W x Lx D): y x y x 4 <br />• ASPHALT 09 CONCRETE 0 BOTH Cl 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 NOJO <br />• BIKE LANE CLOSURE REQUIRED? YES 0 NOJ$ <br />• STREET CLOSURE REQUIRED? YES 0 NO 9. <br />• LANE CLOSURE REQUIRED? YES SI NO 0 <br />• PARKING CLOSURE REQUIRED? YES 0 NO id <br />• OTHER TRAFFIC IMPACTS? <br />• ANY RESTRIPING REQUIRED? YES 0 NO ffi <br />• TRAFFIC SIGNAL LOOP INVOLVED? YES 0 NO <br />• WILL "NO PARKING" SIGNS BE NEEDED? YES 0 NO ld <br />• OTHER COMMENTS TO FACILITATE PERMIT REQUEST? <br />N <br />N�� ' 1 <br />0 <br />S: Drake, Avz- <br />L AAa%A �54, <br />ti <br />