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t • . . <br /> 1 <br /> p���wxT a�puca�rr,e�ra <br /> +���at���s���t� <br /> PUB�IC WORKS USE t3NLY <br /> �Concrete {r�t(n.5`� Y'� N <br /> r �_ <br /> Asphalt Base(min. 6`� Y N <br /> _ � � ___.�� <br /> Asphatt(min. lTlz'� Y N <br /> Lengtfi(min. 19'} Y N <br /> � <br /> �Ivt����,dr I1i�C1^Z�r iT�dSl'� 1• <br /> E�cisting sldewalk. � Y N <br /> New sidewalk Y N <br /> ADA comptiant Y N <br /> Expansion materiat requined, Y N T <br /> Contiguaus par3�ng pad. Y N <br /> Trlangular flare(31N x 71) �1( N <br /> V[sibillty irlangle o.k.? "M N <br /> ---. <br /> Side set E�ack(3'min.R.O.W.} � j N <br /> �/' <br /> � P(an Review Fee <br /> Additiaeai descri #ion of wark as defined b Aubilc Warks Dlrector and or desi nee: <br /> S�.�' o�� O S tG . -- <br /> � __.�__.� � � <br /> j tr.'pt <br /> , . <br /> 4 ��c�v�..._..----. - -- —--°-- i <br /> ��__ �.—. _�__ � <br /> Permft appficatlan approved by: Date: <br /> Rsge 3 of 3 ` <br />