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-0 -7 2 <br /> ' Permit Number <br /> PacificGasarrrl Field Paving Form Permit FxpirationDate: <br /> Electric CernpaRY ��I '1 G l <br /> Street Address: L �v - <br /> Date: <br /> Cross Street: <br /> Foreman Name: �'c�•c�G �)Vi�'� l f Ut'�i <br /> PM Numbers <br /> �i i Q ce CitylCounty: �5 j� '�•—AA, So., aIG 1 c,4i1 <br /> Concrete W x L Depth <br /> -Roadway inches <br /> or <br /> Sidewalk — ches <br /> Color.Y/N � Aggregate;Y I N DecorativelSiamped;Y I N <br /> — <br /> Inches Color:Y I N Aggregate:Y/N DecoratiivelStamped:Y I N <br /> Sidewalk <br /> inches Conor;Y/N � Aggregate:Y I N ) DecorafivelStamped:Y/N <br /> Driveway <br /> inches Color.Y I N Aggregate:Y I N DecorativelStamped:Y I N <br /> Driveway <br /> Curb Ramp Domes:Y I N <br /> Curb If Gutter.Y I N <br /> Valley Gutter If <br /> Dowels 7ea Size:#4195 <br /> Asphalt W x L Depth Adjust/Replace <br /> C inches Manhole Frame ea <br /> Asphalt Sidevralk Gas Valve Box ea <br /> Mill&Fill —inches <br /> ea 13'x24' 17'z30' 24'x36'ea <br /> Asphalt I Concrete Combo 'over= Secondary Electrical Box <br /> ~inches - Valve Frame- 15' � 23' <br /> Grind - — ea 30'x 30'132'x 32'148'x 48' <br /> Valve Cover <br /> Asphalt Fabric <br /> Asphalt Berm/Curb If <br /> Depth Other W x L <br /> Saw Cut <br /> Place Paver I Stone I Brick in Concrete:Y I N <br /> Asphalt Z If inches ea Reflective:Y 1 N <br /> If —inches Traffic Marker Dots <br /> Concrete ea Concrete Asphalt <br /> Seal W x L Plug 1 Y2'Gas Prospect Hole <br /> Slurry l Fog/Sand <br /> Striping <br /> Width Notes <br /> Paint If —inches <br /> Thermoplastic If —inches <br /> Traffic Legend ea <br /> Double Center Lane If <br /> 3M'Scotch Lane If 4-18-112,Crosswalk <br /> . s <br /> IV <br /> ---------------------- <br /> �1UT� <br />