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w <br /> j pacific Gas Coirn`apy. Field Paving r- Permit Number: <br /> Permit Expiration Date: <br /> Date: 5 ` i 2 3 <br /> Street Address: _ /�:��/ ���, �. <br /> Foreman Name: �? �}-t'�i� Cross Street: / 7 <br /> PM Number: ���S g .?j Cin -- g fa�/�y��, <br /> Concrete W x L Depth <br /> Roadway inches-,. <br /> Sidewalk _inches Color:Y/N J Aggregate:Y!N J Decorative/Stamped:Y/N <br /> Sidewalk —inches Color:Y/N J Aggregate:Y/N J Decorative/Stamped:Y I N <br /> Driveway —inches Color:Y/N J Aggregafe:Y I N J Decorative/Stamped:Y/N <br /> Driveway _inches Color:Y/N J Aggregate:Y/N J DecorativelStamped:Y/N <br /> Curb Ramp Domes:Y!N <br /> Curb If Gutter:Y/N <br /> Valley Gutter If <br /> Dowels Ljea Size:#41 #5 <br /> Asphalt W x L Depth Adjust/Replace <br /> Asphaltinches Manhole Frame , ea <br /> Mill&Fill _inchesSidewalk Gas Valve Box ea <br /> Asphalt/Concrete Combo _" <br /> over Secondary Electrical Box ea 13"x�23 <br /> J 17"x 30"J 24"x 36" <br /> Grind _inches Valve Frame ea 15" J <br /> Asphalt Fabric Valve Cover ]j]a 30"x 30"132"x'32"J 48"x 48" <br /> Asphalt Berm/Curb If <br /> Saw Cut Depth Other W x L <br /> Asphalt Elf <br /> If inches PlacePaver/Stone/Brick In Concrete:Y/N <br /> Concrete _inches Traffic Marker Dots ea Reflective:Y/N <br /> Seal W x L Plug 1%z"Gas Prospect Hole ea Concrete J Asphalt <br /> Slurry/Fog/Sand CJS <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 <br />