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400 3L,Os' imL1_�T/II ll F1�ILlf� r)j(1N '1�LII T1 <br />PM# USA# EXPIRES SUBMITTED BY: ZAZZ--1 DATE: �-71ZO <br />PERMIT FOR: <br />NB'. G: E: X EMER ' LK/GRADE GPRP CPRP. <br />IF F_MERGENCY, IS WORK COMPLETED ALREADY? YES o NO o (DATE)? - <br />Scheduled Date <br />DATE PERMIT REQUIRED;_ _ (^`1T <br />u AGENCY(CIT Y, CO UNTY. CALTRANS, OTHER): �anQl�U�i� <br />s VERBAL AUTHORI%ATION OBTAINED YES O NO O <br />(DATE/T IM E/CONTACTI? <br />e LOCATION (INCLUDE DIMENSIONS FROM PROPERTY LINE, NEAREST CROSS STREET, CURB OR OTHER <br />LANDMARKS <br />n DIMENSIONS FOR EXCAVATION (W x Lx D) ><' <br />a ASPHALT ONCRCTE❑BOTH []NO PAVING <br />x114 <br />SIDEWAU( CLOSURE REQUIRED? YES❑ NO'b <br />BIKE LANE CLOSURE REQUIRED? YES O NO\ <br />STREET CLOSURE REQUIRED? YES NOS <br />o LANE CLOSURE, P);UGBt'Gt-f RIC OR. OTHER TRAFFIC IMPACTS ,'--11'ir'? <br />o ANY RE -STRIPING REQUIRED? YES U NO X <br />o TRAFFIC SIGNAL LOOP INVOLVED? YES q N0')Q <br />a WILL"NO PARKING" SIGNS BE NEEDED? YES NO - <br />a OTHER COMMENTSTO FACILITATE PERMIT REQUEST? <br />4 <br />c 4b v 4 • <br />i5 <br />