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� PERMIT APPLICATION <br /> • OFFICE USE ONLY <br /> _.. . _. _,_ . .., . . ,_ .. _ . _ <br /> ' � PUBLIC.WORKS=USE ONLY. � ' � � <br /> Concrete (min. 6'� Y N <br /> Asphalt Base (min. 6'� Y N <br /> Asphalt(min. 1�/z'� Y N <br /> Length (min. 19� Y N <br /> Width (10'min—20'max) Y N <br /> Existing sidewalk. Y N <br /> New sidewalk. Y N <br /> ADA compliant. Y N <br /> Expansion material required. N <br /> Contiguous parking pad. Y N� <br /> Triangular flare (31N x 7'L) Y N <br /> Visibility triangle o.k.? Y N <br /> I <br /> Side set back(3'min. R.O.W.) Y N '� <br /> i <br /> Plan Review Fee <br /> ; . ,.. : . �:. .... _,�:<<: ....,.:, :._ . , , .. ..:.F�,.., :,<-. ;. ,._..:.. __ ._ , ,_ <br /> . . : . .. . <br /> ,Addifional;descri tion�of..'work,,as defned�b`°Public.,Works Director and,or�desi� nee:. . . . . '' ' <br /> ..,:: . .,�..�_. _ <br /> .;: - . . , <br /> S�E �oT�s aN �tJ , rv <br /> Permit application approved by: Date: ��ls , <br /> Page 3 of 3 <br />