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PERMIT APPLICATION <br /> OFFICE USE ONLY <br /> PUBLIC WORKS USE ONLY <br /> Concrete (min. 6 ") 000 N w/ Ww M -F, her C &- Cot-{r4 -foi-� <br /> Asphalt Base (min. 6 ") Y N <br /> Asphalt (min. 1 ") Y N <br /> Length (min. 19') N <br /> Width (10' min — 20' max) Y� N 12 <br /> Existing sidewalk. Y <br /> New sidewalk. Y C <br /> ADA compliant. Y N ►� /A <br /> Expansion material required. (2) N AT AGE ci prt'lEMEiaT C P.'o wy uMe <br /> Contiguous parking pad. Y <br /> Triangular flare (3W x 7'L) l N '5' x V3 1 <br /> Visibility triangle o.k.? N <br /> Side set back (3' min. R.O.W.) dr. N <br /> Plan Review Fee <br /> 1 Additional description of work as defined by Public Works Director and or designee; I <br /> - TuvEtr -rrirc c sT&tatio/0 C M'4 t ST)1 6 S) <br /> SA E OF ?4V MEDT w,/ 8c2 F?CPANS(oll.) 5a <br /> 1 M£T &'A4-)T2.I4 C to R a S rTE l 26/( <br /> Permit application approved by: ■-•■■ ' ate: 4 j ff <br /> Page 3 of 3 <br />