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PERMIT AP�LI�ATION <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'min—20'max) Y N <br /> Existing sidewalk. Y N <br /> New sidewalk. Y N <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.? Y N <br /> Side set back(3'min. R.O.W.) Y N <br /> Plan Review Fee <br /> Additional desai on of work as defined b Public Worics Director and or nee: <br /> / ( '` ` � r� ` 6�� �—E <br /> Permit application approved by: � — zr 1 __ Date: <br /> Rag� 3 cf � <br />