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Pacific Gas and Field Paving Form Permit Number: <br /> Electric company Permil Expiration Date: <br /> Date: '34-7-15 Street Address: <br /> Foreman Name: Cross Street: <br /> PM Number: J 11 S-7(pqq Ctty1 oun S <br /> Concrete W x L Depth <br /> Roadway _inches <br /> Sidewalk _inches Color:Y 1 N 1 Aggregate:Y/N I Decorative/Stamped:Y I N <br /> Sidewalk _Inches Color.Y/N (Aggregate:Y/N ( Decorative/Stamped:Y/N <br /> Driveway Inches Color.Y I N Aggregaie:Y/N Decorative/Stamped:Y/N <br /> Driveway inches Color.Y I N `Aggregate:Y/N Decorative/Stamped:Y/N <br /> Curb Ramp Domes:Y/N <br /> Curb If Gutter.Y/N <br /> Valley Gutter If <br /> Dowels I ea Size:1►4 1 115 <br /> Asphalt W x L Depth Ad)usUReptace <br /> Asphalt `I `�Inches Manhole Frame ea <br /> Mill 8 Fill _Inches Sidewalk Gas Valva Box ea <br /> Asphalt/Concrete Combo over Secondary Electrical Box ea 13'x 24'1 i7'x 30' 24'x 36' <br /> Grind —Inches Valve Frame ea 15' 1 23' <br /> Asphalt Fabric Valve Cover ea 30'x 30'1 32'x 32'148"x 48' <br /> Asphalt Berm/Curb If <br /> Saw Cut Depth Other W x L <br /> Asphalt �If _Inches Place Paver/Stone/Brick In Concrete:Y I N <br /> Concrete If —Inches Traffic Marker Dols ea Reflective:Y/N <br /> Seal W x L Plug i%Gas Prospect Hole �Jea Concrete j'Asphait <br /> Slurry/Fog/Sand I I ] <br /> Striping Width Notes <br /> Paint If Inches <br /> Thermoplastic If _Inches <br /> Traffic Legend ea <br /> Double Center Cane if <br /> 3M'Scotch Lane if 4-18-1 i2'Crosswalk <br /> ! :�` t W <br /> c <br />