Laserfiche WebLink
]P7ERMITTMEJLDC t,CIl'LISTl <br />43272 G7 /� <br />pipU3A GA{iitES SUBMITTEDBY:�. DATE:�0�3IZ� <br />PERMIT FOR: <br />'NBI G; n E: X EMERG; LK/GRADE: GPRP' CPRP, <br />IFEMERGENCY,ISWORI( COMPLETED ALREADY? YES o NO o(DATE)? <br />Sehedufed Date <br />DATE PERMIT REQUIR EO;_^ <br />gGENCY (CITY, OUNTY LTRANS, OTHER): <br />VERBAL AUTHORIZATION OBTAINED YES o NO ❑ <br />(DATE/TIME/CON FACT) <br />o <br />LOCATION (INCLUDE DIMENSIONS FROM PROPERTY LINE, NEAREST CROSS STREET, CURB OR OTHER <br />LANDMARI(5A i <br />4 <br />DIMENSION5 FOR EXCAVATION (W KLx D) x <br />o. ASPHALT4ONCRETE❑BOTH❑NO PAVING <br />� DIAItRI>fOIVS N;III RFsi O'±A7(ON (Io n;i+PoALY, INCRlpE rlpht R;11'in - - <br />ORt7VEY1,AY;IrCONCRT. SIDONAI K. INtr WlIt W00"GB`0fl yrs .. <br />SIDEWALK CLOSURE REQUIRED? YES o NO e-' <br />a 31k LANE CLOSURE REQUIRED? YES o NO d'� - <br />a STREETCLOSURE REQUIRED? .YES NO ra/ <br />o LANE CLOSURE, PARIONGSi-W OR OTHER TRAFFIC IMPACTS (Ord, <br />o ANY RE -STRIPING REQUIRE D?YES o NO 9'- - <br />o TRAFFIC SIGNAL LOOP INVOLVED? YES q NO <br />o -WILL % IJ PARKING°SIGNS BE NEEDED? YES NO C< _ - - <br />a -.OTHER COMMENTSTO FACILITATE PERMCI'.RMEST7, <br />�t <br />4 ®�. 330 =� <br />