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il � <br /> It ,� Q A <br /> l <br /> ° `' PERMIT APPLICATYON <br /> OFFICE USE ONLY <br /> _ - . - - -__:;. - '>3' 'PUBLIC WORKS USE;ONLY.: -- _ ._ -, ,- . <br /> ,. . .. ., <br /> > . . . ,, <br /> , . �::.: <br /> ,., . �,. ..,:. _ - - _ <br /> .: <br /> . �,� . -.:.., :J'r. <br /> ��„ <br /> . <br /> .... ..---. -��� . - .. i� - _- __ <br /> :�:-... <br /> :::. ...'.� . . .� .�'�. a ,r f.1 -�.i '-"v';�.��.�:1 .i)�5 _ _ <br /> Concrete (min. 6'� Y N <br /> Asphalt Base (min. 6'� Y N <br /> � ' <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 <br /> New sidewalk. N <br /> ADA compliant. N <br /> Expansion material required. Y N <br /> Contiguous parking pad. Y N ; <br /> Triangular flare(311V x 7'L) Y N ' <br /> Visibility triangle o.k.? Y N <br /> Side set back(3'min. R.O.W.) Y N <br /> Plan Review Fee <br /> ,:.-,,-.,:._. , ._._,.�.__._„ ,,.-,:,;:�,, - _ �r� - - - - <br /> ' _ _ ..4:��;��� _ - ' ' _ -_ _ , <br /> -�:r:�.:. <br /> e�ined 6'�Public'1Norks Director°and�or;des ee:;�:�:����r;;-"� <br /> �,Addifional�desc�i'�tiori,of�work:as`d f - <br /> � <br /> t <br /> Permit application approved by� � Date: <br /> Page 3 of 3 <br />