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Pacific Gas and Field Paving Form PermiAmber: n- 114OZA <br /> Electric Company' Permit Expirat <br /> ttion Date: <br /> Date: ) `� Street Address: _ (c �5 ifiUji,A __ <br /> Foreman Name: Cross Street: U J <br /> PM Number. i5'� CIWCounty: kmlk <br /> Concrete . :' W x L Depth <br /> Roadway Inches <br /> Sidewalk —inches Color:Y/N I Aggregate:Y/N I Deoorative/Stamped:Y/N <br /> Sidewalk —inches Cokx:Y/N t Aggregate:Y/N I DecorativefStamped:Y/N <br /> Driveway _Inches Color.Y/N I Aggregate:Y/N t DecorativelStamped:Y/N <br /> Driveway inches Color.Y/N I Aggregate-Y/N t Decorstive/Stamped:Y/N <br /> Curb Ramp Domes:Y I N <br /> Curb If Gutter.Y I N i <br /> Valley Gutter If <br /> Dowels ea Size:#41 #b <br /> Asphalt W x Ls: Depth AdJu§tlReplace< <br /> Asphalt ID inches Manhole Frame ea <br /> Mill&Fill _inches Sidewalk Gas Valve Box ea <br /> Asphalt/Concrete Combo over Secondary Electrical Box sa 13'x 24'(17'x 3t}'124,x 36' <br /> Grind _inches Valve Frame ea 15' 123*. <br /> Asphalt Fabric Valve Cover as 30'x 30'132 x 32'148'x 48' <br /> Asphalt Berm 1 Curb If <br /> Sate►66f. .: - Depth' 1N x L: <br /> Asphalt If _inches Place Paver/Stone/Brick In Concrete:Y/N <br /> Concrete FlIf ^Inches Traffic Marker Dots ea Reflective:Y/N <br /> Seal: W z L1. <br /> ' Plug 1% Gas Prospect Hole ea Concrete I Asphalt <br /> Slurry I Fog I Sand W <br /> fig Width Notes <br /> Paint If —inches <br /> Thermoplastic If _inches <br /> Traffic Legend ea <br /> Double Center Lane If <br /> 3M'Scotch Lane' If 4'18-1 12'Crosswalk <br /> b <br /> i <br />