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S�TG <br /> I an€1saas cnF` Paving Fo��ii Permit Number: <br /> FWd P <br /> (?` Ia. atk Cot? au IPermit Expiration Date: <br /> Date: 7 –Z l` t S Street Address: 113(s3 C,P-WJO IN 4U <br /> Foreman{dame: 3oSlnu�T MO6Y'e-_ Cross Street: Ccmur\�- J C. "b <br /> PM Number: 0 C.��fl �. <br /> Concrete W x L Depth <br /> Roadway _inches_ <br /> Sidewalk L i' 4 inches Color.Y 16( Aggregate:Y/tD1 Decorative/Stamped:.Y/9) <br /> Sidewalk _inches Color:Y I N ( Aggregate:Y 1 N ( Decorative/Stamped:Y/N <br /> Driveway _ —inches Color:Y 1 N ( Aggregate:Y/N ( Decorative/Stamped:Y1 N <br /> Driveway _inches Color:Y I N ( Aggregate:Y I N ( 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 /> "Combo <br /> Depth <br /> pth Adjust/Replace <br /> inches Manhole Frame ea <br /> inches Sidewalk Gas Valve Box ea_"over_" Secondary Electrical Box ea 13"x 24"117"x 30"(24"x 36" <br /> _inches Valve Frame ea 15" 123" _ <br /> Asphalt Fabric Valve Cover ea 30"x 30"132"x 32".148"x 48" <br /> Asphalt Berm/Curb If <br /> Saw Cut Depth Other W x L <br /> Ifnches Traffic Marker Dots e inches Place,Paver/Stone!Brick In Concrete:Y/N <br /> Concrete If �i <br /> ��_- � a Reflective:Y 1 N <br /> Se29 W x L Plug 1%"Gas Prospect Hole ea Concrete(Asphalt <br /> Slurry!Fog!Sand W <br /> Striping Width Notes <br /> Paint I Ilf —inches <br /> Thermoplastic If —inches <br /> Traffic Legend []if <br /> ea <br /> Double Center Lane If <br /> 3M"Scotch Lane" 4"18"112"Crosswalk <br /> O <br /> -4 J <br /> 1 \ <br /> IN 170 <br /> r ►� <br /> �t <br /> • T <br />