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' PERMIT APPIICATION <br /> OFFICE USE ONLY <br /> PUBLIC WORKS USE ONLY <br /> Concrete (min. 6'� Y N <br /> Asphalt Base (min. 6'� Y N <br /> N <br /> Asphalt(min. 1�/2'� Y N <br /> Length (min. 19� Y N <br /> Width (10'min— 20'max) Y N <br /> Existing sidewalk. Y N <br /> New sidewalk. Y N <br /> ADA compliant. Y <br /> Expansion material required. N T P,¢ �iriE <br /> Contiguous parking pad. Y N <br /> Triangular flare (31N x 7'L) N <br /> Visibility triangle o.k.? Y N <br /> Side set back(3'min. R.O.W.) Y N <br /> Plan Review Fee <br /> Additional deacri tion of work as defined b Public Works Direcbor and or desi nee: <br /> Permit application approved by: Date: l2 <br /> Page 3 of 3 <br />