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0 <br /> Pacific Gas andField Paving FormPermit Number:Permit Expiration <br /> Electric Company Field <br /> Date: q Street Address: qL I P 1-0 V,&Sb <br /> Foreman Name: Cros <br /> PIVII Number: q a 2-2;-15-to Z, ty/county: to rte. <br /> Concrete X. <br /> Depthj <br /> Roadway inches <br /> Sidewalk inches Color:)'/N I Aggregate:Y N I DecorativelStamped:Y 1 N <br /> Sidewalk inches Color:Y/N I Aggregate:Y/N I Decorative/Stamped:Y 1 N <br /> Driveway inches Color:Y/N Aggregate:Y/N I Decorative/Stamped:Y I N <br /> Driveway inches Color:Y I N Aggregate:Y/N I Decorative/Stamped:Y I N <br /> Curb Ramp Domes:Y/N <br /> Curb If Gutter:Y N <br /> Valley Gutter if <br /> Dowels ea Size:#4 #5 <br /> Asphaltl� Depth`. <br /> Adjust/Replace <br /> As 5i inches Manhole Frame ea <br /> L inches Sidewalk Gas Valve Box ea <br /> Aspha oncrete Combo over Secondary Electrical Box ea 13"x 24"1 17"x 30"124'x 36" <br /> Grind inches Valve Frame ea 15" 123" - <br /> Asphalt Fabric Valve Cover ea 30"x 30"132"x 32"148"x 48" <br /> Asphalt Berm Curb if <br /> Saw Cut <br /> (::!sph;aIt If (o inches Place Paver Stone/brick In Concrete:Y I N <br /> t <br /> e If inches Traffic Marker Dots ea Reflective:Y/N <br /> SbalW X L Plug I W Gas Prospect Hole ea Concrete I Asphalt <br /> :-: <br /> Slurry/Fog I Sand <br /> Strrpmg Width <br /> Paint if inches <br /> Thermoplastic if inches <br /> Traffic Legend ea <br /> Double Center Lane if <br /> 3M"Scotch Lane" If 4"18"112"Crosswalk <br /> ................. <br /> e- <br /> .......... <br /> -Al.- I.. . <br /> Fd-4- PU4nj I <br />