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Pacific Gas and <br />EfecWc Company- permit Field Checklist Job Aid No. JA400 <br />Rev. 0, 312312016 <br />PM#: <br />45269903 <br />Address: Orange Ave & <br />Seidner Rd <br />Agency ❑ City 0 County ❑ other <br />Date: 6/23/2022 <br />Permit for: Modesto M&C <br />Submitted by:CJRF <br />Project Type: <br />(Check all that apply) <br />❑ New Business ❑ WRO 0 Gas ❑ Electric ❑ Emergency <br />❑ Leak ❑ GPRP <br />Agency ❑ City 0 County ❑ other <br />Date permit required: 6/23/2022 <br />Sidewalk closure required? <br />Location (include dimensions from property lines, nearest cross street, curb or other landmark): <br />Approx 8ft north of southern P/L and 14ft west of east side P/L <br />Excavation Width x Length x Depth: 4'x4'x4' <br />Pavement remediation: 0 Asphalt ❑ Concrete ❑ Both ❑ No Paving <br />Trench Width x Length: N/A <br />Pavement remediation: 0 Asphalt ❑ Concrete ❑ Both ❑ No Paving <br />Yes / No <br />Yes / No <br />Sidewalk closure required? <br />❑ ® <br />Any re -stripping needed? <br />❑ <br />Bike lane closure required? <br />❑ ® <br />Traffic signal loop involved? <br />❑ <br />Street closure required? <br />❑ ❑ <br />Will "No Parking" signs be needed? <br />❑ ❑ <br />Check all that apply 0 Lane Closure ❑ Parking <br />Strip ❑ Other Traffic impacts <br />Other comments to facilitate permit request? <br />Traffic control will be used to do work. <br />