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PERMIT FIELD CHECKLIST <br />PM#USAR EXPIRES, SUBMITTED <br />PE <br />Pi !G: e E: X EMERG: LK/GRADE: GPRP; CPRP: <br />OTHER <br />IFEMERGENCY, IS WORK COMPLETED ALREADY? YES,❑ NO b(DATE)7- <br />Scheduled Rete <br />DATE PERMIT EQU _ <br />m AGENCY % , m CALTRANSROTHER): <br />m VERBALAUTHORIZATIONOBTAINED YES -0 NO 0 <br />(IIeTP%TIPAF/MNTA P'T19 <br />DATE: �v9 <br />• LOCATION (INCLUDE DIMENSIONS SROM PROPERTY LINE, NEAREST CRASS STREET, CURB OR OTHER LANDMARKS <br />® DIMENSIONS FOR EXCAVATION (WaLx D) <br />m ASPHALTN( ONCRETUBOTH®NO PAVING <br />m DIMENSIONS FOR RESTORATION (IF ASPHALT, INCLUDE ADDITIONAL FOOTAGE FOR NT" TRENCH OR OVERLAY; IF <br />CONCRETE SIDEWALK. INCLUDE FOOTAGE FOR ENTIRE FLAG OR NEARESTJOINT) N/A <br />® ,SIDEWALK CLOSURE REQUIRED? YES❑ N01l\ <br />m MKELANE CLOSURE REQUIRED? YES•❑ NO w, ' <br />m STREET CLOSURE REQUIRED? YES ❑• NO 0\ <br />m LANE CLOSURE, PARKING STRIP OR OTHER TRAFFIC IMPACTS(Circle)? <br />m. ANY RE -STRIPING REQUIRED?YES ❑ NO' d,\ <br />m TRAFFIC SIGNAL LOOP INVOLVED? YES -0 NO b\ <br />WILL "NO PARKINGN SIGNS BE NEEDED? YES NO rt, <br />m .OTHER COMMENTSTOFACILTTATEPERMITREQUFST? <br />