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<br /> Electric Company Permit Expiration bate;` '
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<br /> Foreman Name: 1,i f -Cross Street:
<br /> PM Number: 311(D?'JO) City ou �
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<br /> Roadway —inches
<br /> Sidewalk —inches Color:Y N Aggregate:Y/ (-Decorative/Stamped:Y/N
<br /> Sidewalk _inches Color:Y N Aggregate:Y N Decorative/Stamped:Y/N
<br /> Driveway _Inches. Color.Y N I Aggregate:Y N DecorativelStamped:YIN
<br /> Driveway —inches Color:Y N I Aggregate:Y N Decorative/Stamped:Y
<br /> Curb Ramp Domes:Y I N
<br /> Curb If- Gutter:Y i N
<br /> Valley Gutter If
<br /> Dowels ea Size:#4( #5
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<br /> Asphalt__ Winches Manhole Frame ea
<br /> Mill&Fill _inches Sidewalk Gas Valve Box ea
<br /> Asphalt I Concrete Combo . °over—" Secondary Electrical Box ea 13'x 24"(17"x 30" 24'x 36"
<br /> Grind _inches Valve Frame ea 15" 123"
<br /> Asphalt Fabric Valve Cover ea 30"x 30"[32"x 32"•(48"x 48"
<br /> Asphalt Berm/Curb If
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<br /> Asp'�ialt_-� If J114inches Place Paver I Stone i Brick'
<br /> In Concrete:Y 1 N
<br /> Concrete , If —inches Traffic Marker Dots ea Reflective:Y/N
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<br /> Plug 1 W. Prosp ea C.o Asphalt
<br /> Slurry I Fog i Sand �]
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<br /> Paint' If _inches /}W
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<br /> Thermoplastic If __inches
<br /> Traffic Legend ea C>4
<br /> Double Center-Lane If
<br /> 3M"Scotch Lane" If 4" 8"(12"Crosswalk
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