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Permit Field Checklist Job Aid No. JA400 <br />Rev. 0, 3/23/2016 <br /> <br />PM#: <br />45269817 <br />Address: S/E corner of <br />Santa Fe Rd & Orange <br />Ave Escalon <br /> Date: Click to enter <br />START date <br /> Permit for: Modesto M&C <br /> <br />Submitted by:CJRF <br /> <br />Project Type: <br />(Check all that apply) <br />☐ New Business ☐ WRO ☒ Gas ☐ Electric ☐ Emergency <br />☐ Leak ☐ GPRP <br />Agency ☐ City ☒ County ☐ other <br />Date permit required: 6/22/2022 <br />Location (include dimensions from property lines, nearest cross street, curb or other landmark): <br /> 10ft east of Santa Fe 10ft South of Orange <br /> <br />Excavation Width x Length x Depth: 4’x4’x4’ <br /> <br />Pavement remediation: ☒ Asphalt ☐ Concrete ☐ Both ☐ No Paving <br /> <br /> <br />Trench Width x Length: N/A <br /> <br />Pavement remediation: ☒ Asphalt ☐ Concrete ☐ Both ☐ No Paving <br /> <br /> <br /> Yes / No Yes / No <br />Sidewalk closure required? ☐ ☒ Any re-stripping needed? ☐ ☒ <br />Bike lane closure required? ☐ ☐ Traffic signal loop involved? ☐ ☒ <br />Street closure required? ☐ ☒ Will “No Parking” signs be needed? ☐ ☒ <br />Check all that apply ☐ Lane Closure ☐ Parking Strip ☐ Other Traffic impacts <br />Other comments to facilitate permit request? <br />Traffic control will be used to do job safely. <br />