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Pacific Oas and <br /> . <br /> Electric Company <br /> Field Paving Form Permit Number: <br /> Permit Expiration Date: <br /> Date: Street Address: �' ? sy✓qt�t/!t •rfF/� <br /> Foreman Name: i Cross Street: <br /> PM Number: D CIWCounty: <br /> ConcreteW x L Depth <br /> Roadway inches <br /> Sidewalk _inches Color:Y! Aggregate:Y/ J DecorativelStamped:Y/ <br /> Sidewalk —inches Color.Y J Aggregate:Y N Decorative/Stamped:Y N <br /> Driveway _inches Color:Y N Aggregate:Y liq DecorativelStamped:Y N <br /> Driveway —inches Color:Y ( Aggregate:Y! Decorative/Stamped:Y <br /> Curb Ramp Domes:Y/N <br /> Curb If Gutter:Y/N <br /> Valley Gutter if <br /> Dowels ea Size:#41 #5 <br /> Asphalt W x L Depth Adjust/Replace <br /> r <br /> Asphalt �j'' s-4 inches Manhole Frame <br /> ea • <br /> Mill 1£Fill —Inches Sidewalk Gas Valve Box ea <br /> Asphalt I Concrete Combo over_' Secondary Electrical Box ea 13'x 24'J 17'x 30' 24'x 36' <br /> Grind _inches Valve Frame ea 15' 123' <br /> Asphalt Fabric Valve Cover ea 30'x 30'1 32'x 32'148'x 46' <br /> Asphalt Berm 1 Curb If <br /> Saw Cut Depth Other W x L <br /> Asphalt �If Inches <br /> Place Paver 1 Stone 1 Brick In Concrete:Y/N <br /> Concrete if inches Traffic Marker Dots ea Reflective:Y/N <br /> Seal W x L Plug 1 Yz'Gas Prospect Hole ea Concrete Asphalt <br /> Slurry/Fog 1 Sand W <br /> Striping Width Notes <br /> Paint If _inches <br /> Thermoplastic If _Inches <br /> Traffic Legend ea <br /> Double Center Lane If <br /> 3M'Sootch Lane' If 4'18-112-Crosswalk <br /> t ' Li i <br /> Ccs 6/ AVI w <br /> L <br /> t <br /> N16 <br />