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PERM��' APPLICATION <br /> OFFICE USE ONLY <br /> PUBLIC WORKS USE ONLY <br /> Concrete (min.6'� Y N � ,,vc.J,v� <br /> Asphalt Base (min. 6'� Y N <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. Y N <br /> ADA compliant. Y N N <br /> Expansion material required. Y N T Eb 0� ,4 M (�E C,(N � <br /> Contiguous parking pad. Y N <br /> Triangular flare (311V x 7'L) Y N S' � 1 3 <br /> Visibility triangle o.k.? Y N <br /> Side set back (3' min. R.O.W.) N <br /> Plan Review Fee <br /> Additional desai n of work as deRined Publlc Works Direcbor and or nee: <br /> v� E' �Q ed v 7� � G <br /> V w � �" /�.� i <br /> � /YI C D / E �t <br /> �" D / i - o - w� <br /> Permit application approved by: Date: �,c�U <br /> Page 3 of 3 <br />