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� PERM�APPLIGATIOI� <br /> OFFICE USE ONLY <br /> PUBLIC WORKS USE ONLY <br /> I Concrete (min. 6'� Y N � �,}� /V�� �evt <br /> Asphalt Base (min. 6'� Y N <br /> Asphalt (min. lYz'� Y N <br /> Length (min. 19� Y t� �Pj — p <br /> Width (10' min — 20'max) Y N (�{ �-- ' �r � ' � �,� ) <br /> � Existing sidewalk. Y N EMp�(� � ls �O� �'l,p � C o Sl,�PE <br /> � New sidewalk. Y N <br /> ADA compliant. Y t� <br /> Expansion material required. Y N T � a� P�� <br /> Contiguous parking pad. Y N <br /> Triangular flare (31N x 7`L) Y N �'C�F S'(�ES <br /> Visibility triangle o.k.? Y N <br /> Side set back(3'min. R.O.W.) Y N <br /> � Pian Review Fee <br /> Additionat descri tion af wark as defined b Rubtic WaNcs Director and or desi nee: <br /> �o� <br /> Permit application approved by: e: �50tUG� <br /> Page 3 af 3 <br />