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THE APPUCAt i HEREBY GER T irIES: <br /> 1. TW he/she has read an the yrs of t hits , that <br /> hfsr"hetkraiiedge,and <br /> 2. That tete is the owner of the mitre property,dr <br /> 3. Thathe1she-will assume full msponsibilit for all city forpersma <br /> ;�r or, to .�arise outof the work <br /> described above,or rh , <br /> ntaY armee out of tt #ire t o Mkt the ' tfd '40k <br /> 4. That in the event any rrri of such.# r 161made the Courter of SaFr or ani to aril <br /> thereof,he stat defend,inderrrrbfy and hob dem tl ;.s <br /> 5. That work shad be <br /> Y#*a_pa6d(bra hof t <br /> indfr�ted ate €�va�d Sart��i <br /> 6. That if perrnjssn is � `+ ars to�'' derflafngrttpe:. + . <br /> : <br /> Of this i. ; <br /> »»»>»»»»>»»»»»»»»»»>>>>na.D ti car <br /> 1. DRIVEWAY: Noa6l, Dirt d Gravel Q �9 C3 ted }' <br /> 2. SLOPING: Away from Pavement &1111TomrdsPaverrW' t I=lat <br /> 3. PIPES: None Exis#f%—Type <br /> Outerpipes`innei0borhhood: Yes No LJ Approadtes <br /> 4. HEADWALL: Yes ❑ No <br /> 5. ASPHALT CONCRETE DIKE: Yes Q No � i r4~440 <br /> 6. BARRIERS: Along Right-of-way A104 <br /> 7. DITCH: Yes ❑, Nof Yes: V Sale n 2 Point Q Lit 0t , <br /> »»>»»»»»»»»»»»>i»»»y»»»y»»>PI,Rgn <br /> 1. DRIVEWAY: SFR ❑ Commercial Ag ,q ❑ Irwustliat bL ,9 <br /> Paved with _"Min Depth A.C.over V AZ.,ow <br /> Notes: <br /> 2. PIPES: Length of Pipe Required Ft.and mete of Pipe irr ss <br /> To be connected to any adjacent driveway pipe Yes Q No <br /> Drainage Inlet Requ � ° Yes O No <br /> Total Length: Nth proposed) Total , ber of-SIS Dry <br /> s. <br /> Notes: <br /> 3. HEADWALL Yes Q No <br /> r <br /> 4. PAVED FRONTAGE: Paved with `` "Min Depth AC,over "Mai tit' X& <br /> Measuring Feet in length std I e I0 Wo <br /> »»»»»»»»»»»»»»»»»»>>>>>> <br /> Driveway Encroachment Permit base fee , $100.0€1 <br /> Field InsDection <br /> Driveway wJ or w/o pipe $107ko P sd F <br /> Driveway wlbox Culvert $175.00 Curb,G <br /> MICE PALSERVICESCLERICAftS-SV.WKIWSTER.PSIENCRQAOHb lTFMk9TDMVEWAY.DOC j1601 NP202 <br />