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C _. <br /> Pacific Gas and Field Paving Form Permit Number: <br /> Electric Company Permit Explration Date: <br /> Date: S��V Street Address: ��7� 7 11Gi Ayf <br /> L.[� <br /> Foreman Name: OS bo Cross Street: <br /> PM Number: 3_I 1 S7(,ggq City ounty: C,klvo I STS <br /> Concrete W x L Depth <br /> Roadway _inches <br /> Sidewalk —inches Color:Y/N I Aggregate:Y/N I Decorative/Stamped:Y/N <br /> Sidewalk —inches Color:Y/N I Aggregate:Y/N 1 Decorative/Stamped:Y/N <br /> Driveway _inches Color:Y I N I Aggregate:Y/N I Decorative/Stamped:Y/N <br /> Driveway _inches Color:Y I N I Aggregate:Y/N I 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 /> Asphalt W x L Depth <br /> just/ <br /> Asphalt �j 5 `�inches Ma 4hole Fra e ea <br /> _inches Sidead <br /> s alve BBd ea <br /> Asphalt/Concrete Combo —"over ; f Seclectripa1 Box ea 13"x24"17'00"124'06" <br /> Grind —inches. Valve Frame",/ ea 15" 123" <br /> Asphalt Fabric Ive Cover ea 30"x 30"132"x 32"148"x 48" <br /> Asphalt Berm 1 Curb If <br /> Saw Cut Depth her W x L <br /> Asphalt 26 If �inches � Place Paver/Stone/Brick In Concrete:Y/N <br /> oncre a �If _inches Traffic Marker Dots ea Reflective:Y/N <br /> Seal W x L ` Plug 1%'Gas Prospect Hole ea Concrete 'As halt <br /> I p <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"18"112"Crosswalk <br /> i c <br /> c <br /> �/b <br />