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<br /> Pacific GnsandPermit Number'
<br /> Electric Company' Field Paving Formp. ,Y
<br /> Permit�Expiration6ate;` :�•��
<br /> Date:r d f2 Z 2" 1 S Street Address:
<br /> Foreman Name: [Xkkt Z I -Cross Street: _ Tt.(_s a
<br /> PM Number:
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<br /> Roadway --..inches
<br /> Sidewalk —inches Color:Y I N J Aggregate:Y/N J.Decorative/Stamped:Y I N
<br /> Sidewalk —inches Color:Y I N J Aggregate:Y I N J Decorative/Stamped:Y I N
<br /> Driveway —inches. Color:Y/N J Aggregate:Y 1 N J Decorative/Stamped:Y I N
<br /> Driveway _inches Color:Y I N J Aggregate:Y/N J DecorativelStamped:Y I N
<br /> Curb Ramp Domes:Y I N
<br /> Curb If- Gutter:Y/N
<br /> Valley Gutter If
<br /> Dowels ea Size:#4 #5
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<br /> p all e23 cinches Manhole Frame ea
<br /> i I&Fill _inches Sidewalk Gas Valve Box ea
<br /> Asphalt I Concrete Combo . over Secondary Electrical Box ea 13"x 24"J 17"x 30'1 24"x 36"
<br /> Grind —inches Valve Frame ea 15" 123'
<br /> Asphalt-Fabric Valve Cover lea 30"x 30" 32"x 32"'J 48'x 48"
<br /> Asphalt Berm 1 Curb If
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<br /> Asphalt If inches Place Paver/Stone I Brick �In Concrete:Y I N`r Y
<br /> Concrete �If —inches Traffic Marker Dots eb Reflective:Y I N '
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<br /> Hole ea Concrete�Asphalt� Plug 1 i/2.Gas Prospect
<br /> Slurry 1 Fog I Sand IBJ
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<br /> Paint* If inches
<br /> Thermoplastic If •_inches
<br /> Traffic Legend e,a
<br /> Double CenterLane If
<br /> 3M"Scotch Lane° If 4"18"112'Crosswalk
<br /> V3 41.2 7' i
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