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PERMIT IT FI E]LD CIUCK]LIST <br />PM#: 45654195 LOCATION: 1702 PALOMA AVE, STOCKTON <br />PROJECT TYPE: New Business El Leak® Corrosion❑ G4E❑ Emergency❑ <br />• If emergency, is work completed already? Yes❑ No® (Date)? <br />AGENCY: City® County❑ CalTrans❑ Other❑: <br />EXCAVATION DIMENSIONS (W x L x D): 4X4X4 <br />r <br />PAVEMENT REMEDIATION: Asphalt® Concrete❑ Both❑ No Paving❑ <br />• Sidewalk Closure Required? <br />Yes El <br />No® <br />• Bike Lane Closure Required? <br />Yes El <br />No® <br />• Street Closure Required? <br />Yes El <br />No® <br />• Lane Closure Required? <br />Yes® <br />No❑ <br />• Parking Closure Required? <br />Yes El <br />No® <br />• Any Restriping Required? <br />Yes El <br />No® <br />• Traffic Signal Loop Involved? <br />Yes El <br />No® <br />• No Parking Signs Needed? <br />Yes® <br />No❑ <br />• Other Traffic Impacts? <br />• Other Comments? <br />LAN ID: MRDE Date: 8/23/23 <br />Other❑: <br />LOCATION (INCLUDE DIMENSIONS FROM PROPERTY LINE, NEAREST CROSS STREET, CURB OR LANDMARKS) <br />N:" <br />AL! <br />11 <br />NN r: <br />S <br />4'x 4' bell hole to <br />repair gas leak <br />r <br />N:" <br />AL! <br />11 <br />NN r: <br />S <br />4'x 4' bell hole to <br />repair gas leak <br />