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r <br /> Pacific Compas any' <br /> Field Paving Form Permit Number: _ <br /> to Electric Cnnrpany' g Permit Expkation Date: <br /> Date: -��-�-"!Sr Street Address: <br /> Foreman Name; Cross Street: ��- <br /> PM Number: � q[s�� Cltyl un -r� <br /> Concrete W x L Depth <br /> Roadway _inches <br /> Sidewalk <br /> —inches Color:Y I N I Aggregate:Y/N I Decorative/Stamped:Y/N <br /> Sidewalk _inches Color:Y/N I Aggregate:Y/N I Decorative/Stamped:Y/N <br /> Driveway —inches Color:Y I N I Aggregate:Y/N I Decorative/Stamped:Y/N <br /> Driveway —inches Color:Y/N J Aggregate:Y/N I Decorative/Stamped:Y/N <br /> Curb Ramp Domes:Y/N <br /> Curb If Gutter:Y/N <br /> Valley Gutter If <br /> Dowels ea Size;#4195 <br /> Asphalt W x L:,. Depth Adjust/Replace <br /> Asphalt -Jo-inches Manhole Frame ea <br /> Mill&Fill —inches Sidewalk Gas Valve Box ea <br /> Asphalt/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' 32'x 32'14W x 48' <br /> Asphalt Berm/Curb If <br /> Saw Cut Depth Other, W x L <br /> Asphalt If _inches Place Paver/Stone 1 Brick In Conaete:Y/N <br /> Concrete HIf `inches Traffic Marker Dotsea Reflective:Y/N <br /> Seat W x 1. Plug 1 9:'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'Sootch Lane' If 4-18-1112'Crosswalk <br /> lei <br /> I I <br /> -1 I Tr <br /> --_. _ _ <br /> i <br />