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Pacific Gas and Field PavingForm Permit Number: <br /> t, Electric Company Permit Expiration Date: <br /> Date: tI,' lo•—)`t.. Street Address: - 51() & 0A <br /> ForemanName: _�GY ps Cross Street: r4 <br /> PM Number: . City/County: L 111"t <br /> Concrete W x L Depth i <br /> Roadway —in, <br /> Sidewalk inches Color:Y/N ( Aggregate:Y 1 N ( Decorative/Stamped:Y I N <br /> Sidewalk _inches Color:Y/N ( Aggregate:Y I N ( Decorative/Stamped:Y/N <br /> Ddveway Inches Color:Y!N J Aggregate:Y!N ( Decorative/Stamped:Y/N <br /> Driveway inches Color:Y 1 N ( Aggregate:Y!N j Decorative/Stamped:Y!N <br /> Curb Ramp Domes:Y 1 N <br /> Curb if Gutter:Y I N <br /> Valley Gutter if <br /> Dowels ea Size:#41 #5 <br /> Asphalt W x L Depth Adjust/Replace <br /> Asphalt inches Manhole Frame ea - <br /> Mill&Fill _inches Sidewalk Gas Valve Box ea <br /> Asphalt I Concrete Combo —'over— Secondary Electrical Box ea 13'x 24'(17'x 30'124'x 36' <br /> Grind —inches Valve Frame ea 15' 123' <br /> Asphalt Fabric Valve Cover ea 30'x 30"1 32"x 32'1 48'x 48' <br /> Asphalt Berm t Curb If <br /> Saw Cut Depth Other W x L <br /> Asphalt If _inches Place Paver/Stone/Brick In Concrete:Y 1 N <br /> Concrete If _Inches Traffic Marker Dols ea Reflective:Y/N <br /> Seal W x L. Plug 1 Y2'Gas Prospect Hole ea Concrete I Asphalt <br /> Slurry/Fog/Sand <br /> Striping `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'(12'Crosswalk <br /> i <br /> 5 � 4ur^lo v ''� �i�d2uxt6K- <br /> 1'1' sr- <br /> �s <br /> w <br />