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PERMIT APPLICAIION <br /> OFFICE USE OMLY <br /> PUBLiC WORKS USE ONLY � <br /> Concrete min.6 Y N • <br /> Asphalt Base(min.6� y � <br /> AsphaR(min,l�h� Y N <br /> Length(m1n.19� ` N <br /> Wldth 10'mtn-20'max} Y N <br /> ExLsting sidewalk 'Y N <br /> New sldewalk Y N <br /> ADA compllant - ry <br /> Fxpansian matertal required. Y N <br /> Contlguous parWng Y N <br /> Triangular flare(31N x 7'L) Y N ' <br /> Vlstbil0.y triangle o.k.7 N <br /> Side set back(3'mfn.R,O.W,) ry <br /> Plan Revlew Fee <br /> Addidonai descri tion of work ae deflned Pu61(e Works Director and.or.desi nee: � <br /> G C <br /> �� <br /> Permit a pllcatlon ap ved by: Date• � <br /> Page 3 of 3 � <br />� - - � <br />