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THEAPPLICANTHEREBY CERTIFIES: <br /> :. .w , <br /> 2. Tb**MeOWM of the ,or is represent owner•£and <br /> . ' asotim, <br /> i# t��fyy t t for t�*. -k 1FTjl y o t en t�}p�,tt VY�iG�I f�IC�jt a�iS�{ ,t �1?C��C <br /> � r t wEi7t�',i of Vt hlre ,to dv �, { hl, rtW <br /> 4. at in the event pert•L1f Ijab ty i$�t�the Cwr of 6w quip or.any, �tr�` r� <br /> h6 tndihlfy and there acrd of therd h. <br /> 5 fc adl pe nes# ' t1wappocot aukz any the C;o€n# }fit <br /> w °va `�t Enoro�est tf <br /> &. t Iseagrees to do the in etxordance wft all tetras,ognMon wd tairtft <br /> ofors <br /> , <br /> pedal III pwisions, <br /> '71le <br /> T& UW6 <br /> >>»»> > >.»sps»>>»a» »»»»»»>**& :*jp <br /> 1 DRiVEAY: None C1 Dirt ' � D Aggregate ❑ Paved(om) r] Paved(good) M <br /> 2. SLOPING: Amy from Payr Towards pavaTlent Fiat �-~ <br /> 3 PIPES:: None Existing—Type, <br /> O*w 00006L <br /> n� omd: Yes No Croom Sim <br /> 4. HEADWALL: Yens No . <br /> 5 ASPHALT CONCRETE PIKE: Yes M ;No <br /> s; BAMSRS: Way <br /> 7 DITCH: Yes M No Yes: v Style ® 2 Point Othar �° Width Depth <br /> »»»»»»»»»»>»»»»»»»»»»>>»»>PBVW Pei l «ccccrc<cccc<c ccaK<c€+c<�ce ac«�r«+ <br /> 1. DRIVEWAY: SFR W 'C..om M Agoulture M Industrial <br /> Paved w'tpt RAin Depth A.C.over `� ",tin Depth Y,"A.B.over <br /> Notes: �° '3 *.E �� " 5 <br /> 2. PIPES Length of Pipe Required 14- Et.and Diarneter of Pipe <br /> To be connected l to any a jaoent driveway pipe Yes No <br /> ft Irde# Yes Plc <br /> Total Length: " (wilt primed) TotafNurn <br /> bar of Stun Drain Inlets: <br /> Notes: <br /> 3. HEADWALL: Yes ❑ No , <br /> 4. PAVED FRONTAGE Paved r ^Mn'I with A.C.over «Mir:Int I/V A.6. <br /> Measuring LL Feet in length and Feet N1 wlt tt <br /> r'i">'J'Sr�"�I�a.}Y.'J`i".?» '"J4?��''>yr.�U`'»>�!>�`✓�'»!a'>r J'>?.`�w'?�✓>.?.7r"�.'!'+7>�">I�'�"�i'4`'�diC<C!4CcV"iii"rrWd`i*'i�.''1°. r1;<'�`'li�.�r<'�+'C'F.<`+a'�`w'46i't"«'Gdr<fi�i<'�+"r'�r <br /> Driveway Encroad ent Permit base;*_$100,00 <br /> DOMON � <br /> ipe ipt 1$107.04 r Paved� e $113.00 t 0.5z%. <br /> what tierSidew, lk� $110.00+1.051ft. <br /> arc s MLER iIPUB-$V,W%WAsrS:esa MOACMWrrr€ MVEWAY:i)OC :+OMI p2020f2 <br />