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PEIRMIT APP�ICATION <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� 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 /> � D [O 2�Yit'i cr /Lo P�t.tY <br /> Triangular flare(3'W x 7'L) Y N � /NG <br /> Visibility triangle o.k.? Y N <br /> Side set back(3'min. R.O.W.) Y N <br /> Plan Review Fee <br /> Additional descri n of work as defined Public Works Direcbor and or d eee: <br /> A � � D � / U /Lj <br /> Permit application approved by: Date: (1� <br /> Psge 3 of 3 <br />