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1. 11Y11.11p C.1V a.w au uw.fxv.r..v.r.��•�I't���""� rr....v wwas aY.avr �...�� rr— ____�___�.�__._�____.__�..___ <br /> kwwhwge;and <br /> 2. Md helshe is the owner of the respective property,or is q"Ufied to represent the aws>,and <br /> 3. That halslte will assume fall vRNMVitY for all Gahifily ExParsooai AM urd wnV m property wbiohmay arise out ofthe wodc described abovq <br /> or which may arise out of Ws�laer f s to do wadr prarvided heron;and <br /> 4. That in tb event any claim of each laabilrty is meds agpiest fiWCamty of San or ea►y,depm4neeet,afCW or=4AOYee be shall <br /> defend,indemnify and boWtbem and each far such da>�and <br /> 5. That work shall be peckmed by the applica*and/or any repeeaeatWft of the ap&cw t in She County Rigbiof-ofat the above indicated site <br /> with ays d San Joaquin Coady Fawoa&nest Paved;and <br /> 6. Tbrt if permisaiaP' as lee agrees to do the wady deecabed in aooarrlaaoe with elf tezws,ooh and reat�iction aftiris and any <br /> attacheA 22, <br /> ar III prriaisione � <br /> 8;gwdor�eafTitle -nuc.° <br /> MM nu(SPEcrORCONMaw s <br /> WaSTENGCONDrnom <br /> L DRIVEWAY: Naos ❑ l ❑ GMNOl lr�y Afigr°grteBase Q Paved(Pon') ❑ Pave-(Oood) ❑ <br /> 2.SLOPINGe Aw�ayyfrvmPavement ❑ TowardsPavaesu t ❑ Flat <br /> 3:pI7B8:. Noce 1 'u_ -ape <br /> Othwpipw is neighborhood: Yea ❑ No Appmsch s Crow Drain ❑ Size <br /> Aftwbmesttoaeigldm%pipe: Yee ❑ No <br /> 4.HEADWALL- Yes ❑ No' , <br /> 3.ASPHALT CONCEM DUM-: Yea ❑ No <br /> 6..BARRIFRS ak"Rigbt c&W#* <br /> 1. DUCK Yue ❑ No � IfYae:- V&* ❑ 2 P6int ❑ Olhw ❑ Width Depth <br /> L DRIVEWAY: SFR, COMMERCIAL ❑ AORWMTURI& ❑ DMLTSTRIAL ❑ <br /> PAVED vMh. IF hfi&Depth A.Q over "Mw Dsplh 3/4"A.R <br /> Nates <br /> 2. PEM& Lanyh ofpipe Requirod:' FL and Dindoler of Pipe its <br /> To be.00aoeoted to any adjacent driveway pipe <br /> Yee <br /> .No — <br /> DRAINADE DaET REQUMD Yes ❑ No <br /> Total Laogth: (withproposed) Toruli Nmaber eSStsran:Drai�T <br /> Natae <br /> 3. HEADWALL Yee Q No <br /> 4. PAVED FRONPADE: PAVED with Wm Depth A.Q over "Min.Depdx 3/4"AB. <br /> Masurhag Feet in kug6i and Fed in width <br /> • 1PEF.H . <br /> Driveway Faaoubm t Permit bees fns_. .r...:. .. ...: <br /> ❑ <br /> $95. <br /> Feldlnsectidn <br /> AIMMy w/or w/o pips....._ $ . <br /> ❑Pavedfa &_ ._.. _ .._ .$100.00+0.46/ft <br /> sDdvwaywftxC hw.L_ _. ----- <br /> ❑sub,ciumer,smawa&--'.................$100:00+o.9ft <br /> CauafalC er;cAAw=V40iwA=for PecmhslDriy�eway And Paved PrustsRe Page.2 of 2 Revised 8%2000. <br />