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In Concrete:Y /N <br />Reflective:Y /N <br />Concrele IAsphalt <br />1--__1"ea <br />I--_--Ieaea 13"x24"117"x30"[24"x36"1----1 ea 15"1 23"1----1,--_-,ea 30"x 30"[32"x 32"[48"x 48" <br />Permit Number:_ <br />Permit Expiration Date: <br />Notes <br />oih~r Wx L <br />Place paver /Stone /Brick ~ <br />Traffic Marker Dots ea <br />Plug 1 y,"Gas Prospect Hole ea <br />AdjusVReplace <br />Manhole Frame <br />Sidewalk Gas Valve Box <br />Secondary Electrical 80x <br />Valve Frame <br />Valve Cover <br />Color:Y6J),Aggregafe:Y @ Decorative/Stamped:v0 <br />Color:YIN 1 Aggregate:Y /N I Decoralive/Stamped:YIN <br />Color:Y /N I Aggregate:Y /N [Decoralive/Stamped:Y /N <br />Color:YIN 1 Aggregate:Y /N I Decoralive/Stamped:Y /N <br />Street Address:LflJ,lfl e«rrernor1f <br />.cross Street:ellen.st=.citye:~)~.:s~~~rl~------ <br />Field Paving Form <br />_inches. <br />_inches <br />Depth <br />h--inches <br />_Inches <br />inches <br />inches <br />_"over <br />inches <br />.Wi!lth <br />ea <br />f <br />f 4"18"112"Crosswalk <br />_inches <br />~inches <br />Inches <br />_inches <br />Inches <br />Domes:Y /N <br />f Gutter:Y /N <br />f <br />ea Size:#4[#S <br />DePth <br />I <br />I <br />I <br />I <br />CD <br />~.0.lfL-jlfw'xL <br />I <br />'"(" <br />I <br />I <br />Pacific Gas and <br />Electric Company' <br />(j3Jd~hb&r1os so+e> <br />31~-z,&(P7 't <br />Asphalt <br />Asphalt <br />Mill &Fill <br />Asphalt /Concrete Combo <br />Grind <br />Asphalt Fabric <br />Asphalt Berm /Curb <br />Saw.cut <br />Asphalt <br />Concrete <br />S~al <br />Slurry /Fog I Sand <br />Striping <br />Paint <br />Thermoplastic <br />Traffic Legend <br />Double Center Lane <br />3M "Scotch Lane" <br />Roadway <br />Sidewalk <br />Sidewalk <br />Driveway <br />Driveway <br />Curb Ramp <br />Curb <br />Valley Gutter <br />Dowels <br />PM Number: <br />Foreman Name: <br />Date: <br />-~"~ <br />~~~ <br />VI <br />~ <br />-I <br />Nt <br />E.fremont ST;