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�ERMIT APPLICATION <br /> OFFICE USE ONLY <br /> PUBLIC WORKS USE ONLY <br /> Concrete (min. 6'� Y N <br /> Asphalt Base(min. 6'� Y N <br /> Asphalt(min. 1�/z'� Y N <br /> Length (min. 19� Y N <br /> Width (10'mi —20'max) Y N � � T <br /> Existing sidewalk. Y N <br /> New sidewalk. y <br /> ADA compliant. Y N <br /> Expansion material required. Y N � <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.) N <br /> Plan Review Fee <br /> Additionai desai n of work as deAned Public Works Direcbor and or desi nee: <br /> � iv r,� .�' c T � �v �vr S � <br /> F w N v c ic �i -o _w <br /> Permit application approved by: Date: E Q <br /> Page 3 of 3 <br />