Laserfiche WebLink
1�1H 1 °I�Il 1�IDE)L rL'1' % DIST <br />PM# USA# E(PIRES SUBMITTEDBY: W-40 DATE: k/Ly/gp <br />PERMIT FOR: <br />No: G: of E: X EMERG; LK/GRADE. GPRP: CPRP, <br />IFFMERGENCY, IS WORT( COMPLETED ALREADY? VES ❑ NO o (DATE)? <br />Schedf&d slate <br />DATE PERMIT RERWRED: _ <br />a / GENCY (CI, C Un _CALTRANS, OTHER): Se-w J <br />p VERBAL AUTHORIZATION OBTAINED YES o NO ❑ <br />(DATE/TIME/CO NTACF)7 <br />u LOCATION (INCLUDE DIMENSIONS FROM PROPERTY LINE, NEAREST CROSS STRFFI, CURB OR OTHER <br />LANDMARKS/ / <br />DIMENSIONS FOR E7(CAVATION (W xLxD} 4 x <br />s. ASPHALTgCONCRETEk3OTI-;�INO PAVING <br />u <br />0I0.98i3lplig cclR:iF.3TfJRf]�GIiOPl�'*ALY,KIdll00i:All, it I MfMl FOinp.liE r IR 9"KdU'Nt7' <br />OROVERL/AYIIfC.ONCAMESIDONALK.IPICi.UUCPCpiAa.maSPF;IRF."FI <br />NIA / <br />o SIDEWALRCLOSURE REQUIRED? YES ❑ NOO <br />o BIKE LANE CLOSURE REQUIRED? YES O NOp - <br />• STREET CLOSURE REQUIRED? .YES NO� <br />• LANE CLOSURE, NARKING Si R(P OR OTHER TRAFFIC IMPACTS(CR•±Se)? <br />• ANY RE-STRIPING REQUIRED? YES o NO xl� - - - <br />o TRAFFICSIGNAL LOOP INVOLVED? YES LI NO� <br />o" WILL "NG PARKING" SIGNS BE NEEDED7 YES- <br />6.OTHER COMMENTS TOFACILMATEPERMITAEQUEST7. <br />