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C - <br /> -;� Pacific a,G 1Field Paving Form <br /> j Permit Number: <br /> Permit Expitrio C <br /> ration Date; <br /> Date: Street Address: Sgo <br /> Foreman Name: S. U-,*, .S Cross S t: S• kh4"ere)5 <br /> PM Number. ��3q�7� Ci ouniy: S EES j <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 1 N 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 Nea Size:#41 #5 <br /> Asphalt W x L Depth Adjust/Replace <br /> Asphalt g IZ inches Manhole Frame ea <br /> Mill&Fill _inches Sidewalk Gas Valve Box ea <br /> Asphalt 1 Concrete Combo _"over Secondary Electrical Box ea 13"x 24" 17"x 30" 24"x 36" <br /> Grind _inches Valve Frame ea 15" 23" <br /> Asphalt Fabric Valve Cover ea 30"x 30"1 32"x 32".148"x 48" <br /> Asphalt Berm/Curb If <br /> Saw Cut Depth Other W x L <br /> Asphalt Elf <br /> If _inches Place,Paver/Stone/Brick InConcrete:Y/N <br /> Concrete inches Traffic Marker Dots ea Reflective:Y/N <br /> Seal W x L Plug 1%"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"18"112"Crosswalk <br />