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Coo OTT <br /> Pacific Gas Grid <br /> FieldPermit Number: <br /> Paving Forr�i>`il <br /> Elpeot rc C-drapan-v Permit Expiration Date: <br /> Date: Street Address: 9/ 7 - S. Q f("t/ C- A(/L <br /> Foreman Name: Cross Str t: O X-N Sf% <br /> PM Number. 31 6 -1 0 �.� Ci Cn .ouS C , 5A� <br /> Concrete W x L Depth <br /> Roadway _inches_ <br /> Sidewalk _inches Color:Y I N Aggregate:Y I N Decorative/Stamped:Y I N <br /> Sidewalk _inches Color:Y I N Aggregate:Y/N Decorative/Stamped:Y I N <br /> Driveway _inches Color:Y IN Aggregate:Y/N DecorativelStamped:Y/N <br /> Driveway _inches Color:Y I N Aggregate:Y I N Decorative/Stamped:Y I N <br /> Curb Ramp Domes:Y I N <br /> Curb If Gutter:Y I N <br /> Valley Gutter If <br /> Dowels ea Size:#4 1 #5 <br /> A W x L Depth Adjust/Replace <br /> Asphalt_---' `f 9 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"1 17"x 30"1 24"x 36" <br /> Grind _inches Valve Frame ea 15" 23" _ <br /> Asphalt Fabric Valve Cover ea 30"x 30" 32"x 32". 48"x 48" <br /> Asphalt Berm I Curb If <br /> S Depth Ofiher W x L <br /> Asphalt If inches Place,Paver/Stone/Brick In Concrete:Y I N <br /> oncrete �If _inches Traffic Marker Dots ea Reflective:Y I N <br /> Seal W x L Plug 1 YT Gas Prospect Hole ea Concrete Asphalt <br /> SlurryI Fog/Sand W <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 /> t i i 1 4 <br /> lrO vrt_1. 5�, <br /> 1 17 <br /> 5• <br /> olive I S' <br /> !! I <br />