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Pacific Gas andElet:lric CUmpi1I1V.Field Paving Form Permit Number:_
<br />Permit Expiration Date:_
<br />Date:'Lt 1115""
<br />Foreman Name:~\S~'_O~\)~\oJ_'_
<br />PM Number:l.j Zle'lS5Z{
<br />,W.dth
<br />.,,"
<br />WxL
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<br />I---Iea 1~E~~"__,_
<br />~_=__=_-_---,-lea 30:x}0:[32"x32'[48'x 48'"
<br />"'-1.3 ::>M",,6~
<br />IN "'"2-~•.•,-00->
<br />~~(="1>"""(,1<.'<1>,,
<br />Other,
<br />------,-~-,-,--..---,-Place Paver /Stone /Brick InConcrete:Y/N----------Traffle Marker Dots ea Reftecllve,Y /N
<br />Plug 1 y,"Gas Prospect Hole ea Concrete IAsphalt
<br />Notes
<br />Adjiistf'RepJi,ce ',~
<br />Manhoie Frame
<br />Sidewalk Gas Valve Box
<br />Secondary Electrical Box
<br />Vaive Frame.---"--'.._--.._-
<br />Valve Cover
<br />'Color:Y /N [Aggregate:Y iN [Decorative/Stamped:Y /N
<br />Colo~:YJ_~li\~9'e~_~te:Y/_N 1~eco~alilJe/~t~mpedY /,N
<br />Gala!:YJ_Nl Ag~r,gate:Y '-N_Ll2.ecor!'.tiv~/.?taITIP"d:YI_~
<br />Color:Y /N I Aggregate:Y /N [Decorative/Stamped:Y /N
<br />Street Address:
<br />Cross Street:
<br />Ci~U5'D
<br />"
<br />iiii"'-tii '---p,-..
<br />--'Linches
<br />inches
<br />__'over
<br />Inches
<br />I
<br />{j {
<br />-If
<br />,-.ce .••..•.~-.--_-'-"._~VY~'.l!.__/:!?ept!i-',,"''"":
<br />inches
<br />Inches
<br />inches...._----.__'inches--,..__.._-_.
<br />inches
<br />Domes:Y /N
<br />f Gutter:Y /N
<br />ffea Size:#4[#5
<br />,D"p_li".
<br />,ULJif~~~-inch~-L-jlf __Inches
<br />'W,x If,
<br />Roadway
<br />Sidewalk
<br />Sidewalk
<br />_~~~e:~.~
<br />Driveway
<br />Curb Ramp
<br />Curb
<br />~all,,!,G~tter
<br />Dowels
<br />A~phalt
<br />Asphalt
<br />Mill &Fill
<br />Asphalt /Concrete Combo
<br />Grind
<br />AsphaltFabric
<br />Aspha!t Berm1Curb
<br />saweut
<br />As~~ait
<br />Concrete
<br />Seal
<br />Slurry /Fog /Sand
<br />Striping
<br />,4"[8"112"Crosswalk
<br />It Inches......._-_.__.
<br />ff __inches
<br />ea
<br />I
<br />I
<br />Paint
<br />!h~rmop~as~i?
<br />Traffic Legend
<br />Double Center Lane
<br />3M "Scotch Lane"
<br />--'~-',i,
<br />I
<br />!
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<br />1 I 1 .~":i :'"I i i :::'i I I I I :':I ,I i I!I
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<br />t;.""I !:I !I !I I
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