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Pacific Gas and Field Paving F <br /> f Electric Company gorm Permit Number: <br /> ll�( .PelrmitE`xpiration Date: <br /> Date: 1 '��l 1 Street Address: 1� 1}�' S4 <br /> Foreman Name: Clw' OS 0 c- Crosq S reet: r <br /> PM Number: UZZTS11.1`%Z- Ci Coun . S r cx � 5 <br /> Concrete W x L Depth <br /> Roadway =_inches <br /> Sidewalk _inches Color:Y/iJ Aggregate:Y/N Decorative/Stamped:Y/N <br /> Sidewalk _inches Color:Y/N I Aggregate:Y/N Decorative/Stamped:Y/N <br /> Driveway —inches Color:Y/N Aggregate:Y/N Decorative/Stamped:Y/N <br /> Driveway _inches Color:Y/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 ea Size:#41 #5 <br /> AspRl W x L Depth AdjustlReplace <br /> sphalt inches Manhole Frame ea <br /> Fill 7 _inches Sidewalk Gas Valve Box ea <br /> Asphalt/Concrete Combo _"over_" Secondary Electrical Box ea 13"x24"1 17"x30"124"x 36" <br /> Grind _inches Valve Frame ea 15" 123" <br /> Asphalt Fabric Valve Cover ea 30"x 30"132"x 32"1 48"x 48" <br /> Asphalt Berm/Curb If <br /> Saw Cut Depth Other W x L <br /> Asphalt If t inches Place Paver/Stone/Brick In Concrete:Y/N <br /> trete If _inches Traffic Marker Dots ea Reflective:Y/N <br /> Seal W x L Plug 1%"Gas Prospect Hole ea Concrete I Asphalt <br /> Slurry!Fog/Sand <br /> Striping Width Notes <br /> Paint If _inchesA 5 � �� � U� � � <br /> Thermoplastic If _inches <br /> Traffic Legend ea <br /> Double Center Lane If <br /> 3M"Scotch Lane" If 4"18"112"Crosswalk <br /> 1 1�. _ <br /> Q Shdrr\ /Owe <br />