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Field Paving Form Permit Number. <br /> P_r�c Ef£G I��xtFz�iGEprf <br /> Permit Expiration Date: <br /> Date: ��� Street Address: <br /> Foreman Name: Z— ,/e r a Cross Street: r+� _ <br /> PM Number: U3,� ," City <br /> Concrete W x L Depth <br /> Roadway _inches <br /> Sidewalk _inches Color:Y/N Aggregate:Y/N Decorative/Stamped:Y/N <br /> Sidewalk _inches Color:Y/N Aggregate:Y/N Decorative/Stamped:Y I N <br /> Driveway inches Color:Y/N Aggregate:Y I N Decorative/Stamped:Y/N <br /> Driveway _inches Color:Y/N Aggregate:Y/N Decorative/Stamped:Y/N <br /> Curb Ramp Domes:Y 1 N <br /> Curb If Gutter:Y/N <br /> Valley Gutter If <br /> Dowels ea Size:#4 1 #5 <br /> Asphalt W x L Depth Adjust/Replace <br /> Asphalt 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"117"x 30"124"x 36" <br /> Grind _inches Valve Frame ea 15' 1 23" <br /> Asphalt Fabric Valve Cover ea 30"x 30"132"x 32"148"x 48" <br /> Asphalt Berm/Curb Hif <br /> Saw Cut Depth Other W x L <br /> Aoncrebte <br /> 2 Z If inches Place Paver/Stone/Brick In Concrete:Y/N <br /> � If _inches Traffic Marker Dots ea Reflective:Y/N <br /> Seal W x L Plug 1'/2"Gas Prospect Hole ea Concrete 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"Scotch Lane" If 4" 8" 12"Crosswalk <br /> S� - <br />