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To <br /> l and thstthe desmVtwn included in this application are correct to the best of his/her <br /> 2. TkfttI" :* 4vW ofthe respeahve property,or is qualified to represent the owner,and <br /> 3. T fD331 tesponsil -�t3'fat'prsgnal siijur}or damage to property which may arise out of the work described above, <br /> W c��Matra�Ci d�dt�rovued lteaein;and <br /> 4. t the Coin+of San loar}ittn or any departmial ent officor employee thereof he shall <br /> aade$dti for such claire;and <br /> tiwe of the applicant in the County Right-of-Way at the above indicated site <br /> VA, ht",and <br /> 6. TttAlifrapot4bo igma to dA the work described in accordance with all terms,conditions and restriction of this and any <br /> 1 00 <br /> :Wolial <br /> T1e Date <br /> * 1?XLD INSpECTO t COMMENTS <br /> > y»a>> 7»»>7»>a»Y»»»»»»»>MMTING CONDITIONS««««<<«««««««««<,«««<.«« <br /> Xt None ❑ Dirt Gravel ❑ Aggregate Base ❑ Paved(poor) ❑ Paved(Good) ❑ ?? <br /> 2 SCOANCe Away from FAWMAW ❑ Towards Pavement ❑ Flat ❑ <br /> 3. None -Type <br /> Odkarpipes in Yes 1_J No ❑ Approaches ❑ Cross Drain ❑ Size / u <br /> Aft to . pipe Yes ❑ No <br /> 4 Yes ❑ No <br /> Dl Y'da ❑ No <br /> � a#opg �itay <br /> 7. iii Yes [No ❑ TfYes: V We ❑ 2 P.W Other ❑ Width Dept <br /> y�,» yy y»ma y>y>> P�REQUIREIAFNTS«««««««««««««««««««« <br /> 1. BIiCI J 4s° .: SFR ❑ C36Il�CIAL ❑ AGRICULTURE ❑ INDUSTRIAL ❑ <br /> PAYED with "Min.Depth A.C.over "Min.Depth 3/4"A.B. <br /> No6es <br /> 2 VVM& tAv4phofPirgam; Pt.and Di=wter of Pipe Inch <br /> To be dated to a driveway pipe Yes ❑ No [} <br /> DRA24AGE MET R9QtMW#3 Yes ❑ No Q� <br /> Toil (with proposed) Total Number of Storni Drain Wets <br /> Notes <br /> 3. M&WWALL Yes ❑ No <br /> 4. PAVW li t+TAM PAVEDft "Min.Depth AC.over "Min.Depth 3/4"AB. <br /> Measuring Feet in length and —Feet in width <br /> FEES <br /> Driveway Fit Pemrit base fee .......S85.00 <br /> Field Inspection _ <br /> ❑Ddvewt+ayW/orIWOpipe­........................................ ...$95.00 !� Paved frontage..................................5100.00-0.46/ft <br /> ❑Driveway WboxCutwt ......... ..........$155.00I Curb,Gutter.Sidewalk_....................$100-00 0.98!8 <br /> Counters,e:V*,,MWpfic ation fir PermitaUive-way and Paved Frontage Page 2 of 2 --M-— Revised 8/2000 <br />