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PERMIT APHLICATION <br /> OFFICE USE ONLY <br /> PUBLIC WORKS USE ONLY <br /> Concrete (min. 6") Y N "��-t�.+.� N �2. p, W, <br /> Asphalt Base (min. 6'� Y N <br /> � <br /> Asphalt (min. 1�/z'� Y N <br /> Length (min. 19� Y N �'7 , S <br /> Width (10' min — 20' max) Y N �JoT To �jCC�Eb 20 <br /> Existing sidewalk. Y IV <br /> New sidewalk. Y N <br /> ADA compliant. y N N <br /> Expansion material required. Y N 5 �,p D �� <br /> Contiguous parking pad. Y N <br /> Triangular flare (3'W x 7'L) Y N <br /> Visibility triangle o.k.? N <br /> Side set back (3' min. R.O.W.) Y N E/Lt���l'j �( (�S�C�a,� <br /> Plan Review Fee <br /> Additionai desai tion of work as def�ned b Publk WoMcs Dlrector and or nee: <br /> • ,DR/VE s ALC �'ET /ST/NG 6�21iDF <br /> ' J �i¢ .tr � <br /> Permit application approved by: Date: / <br /> Page 3 of 3 <br />