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1.. That hedsm nes rema ae the provmms 4H lata cwt+,mm umt unr ummvu st nwa�.s.a .�.r.•...•••••••••••••••••�•••.••., ..�....�._.....� <br /> kODv sad <br /> 2. Tbat hdmhO imthe owner of the respective property,or is qualifiedto Mxesattdo awrim and <br /> 3. That hdske will asmulm fall raepamuUity for ail fiWdily ExPmonai iW"Ordanage to properly which mW arise out ofthe work descnl)ed above, <br /> or which may arise out of his&er More to do the wmk provided hexa aad <br /> 4. That in the ava t&nY c3aim of such Eby ismarl's agpind ilwc u ty of Sm]m*m or uy depwwmu*ofCial err cmpinym thereof;he shall <br /> defend,lode*and holdthem and each of than hamhiaea for mach daimr,and <br /> S. That work Shall be perfarmpd by the applim*aad/cr any rVmantative of dw applicamt in the County Rightof--Way at the above indicated site <br /> wil h a valid San Joagmn Coady Fmoadlmetd Pemtit;and <br /> b. That if Pmm18sioa is granted as regihested,he agrees to do dw wads deco bed inscaordanoe withall tonna,000ditiom and restriction afthis and atW. <br /> attached sheet,inchtded <br /> 2S� <br /> Sigoatm+aofApplimm6lide Date <br /> FIELD IRSPECTOR CORMUM <br /> »»EXWENOCONDMOM«««««««««««««««««««« <br /> L DBIVEWAY: Now Dixt ❑ 0mvei ❑ Aggtngate Base ❑ Paved(Iwa•) Cl Paved(Ciood) ❑ <br /> 2`SLOPINGe Amy fmm Pavamant ❑ Towa<dm Pavammt ❑ Flat <br /> 3:PIllI+B:. Now EAN&g-'Tpe <br /> Odmrpipes i[L=W bodK*& Yes ❑ No Approaches Cromer Drain ❑ Sime <br /> AttubmattioneigbWe pyw Yea ❑ No <br /> 4 HEADWAi:it,: Yea ❑ No" <br /> S.ASPSALT CONC RITE DLft1t:; Yes ❑ Na <br /> &IIARREMS ak"Right•a&Way <br /> 1. DITCH Yes ❑ No IfYes:• V Style ❑ 2 POW ❑ OthW ❑ WMft Depth <br /> ?»»»»»»»»»»»»»»»»»»>PERMITREQUMElMM<z««««««««««««««<<«««« <br /> L Dii WWAY: SFR COM&MCL4L ❑ AGRJr—MTUU ❑ INDUSTRIAL. ❑ <br /> PAVED whit �i "Mp Depl>S AC aver "M3m.Depot 3/4"A.B. <br /> Nates <br /> 2. PMMS% Lena*ofPipe Re"ired: PL and Diamdeier of Pipe Lneh <br /> Tobe.comimectedtoanya4wutt*vvwnypipe Yea ❑.No fl0� <br /> DRAINAGE INLET REQUIRED Yea No <br /> Tow Lmhg& (with Proposed) Total Nam6er of Steffi Drdn lbblda <br /> Nut m <br /> 3. BY"VALL Yes © No <br /> 4. PAVED FRONTAW- PAVED with "bfm.Depth AG over - "Min.Dep&31V AIS <br /> Meastaimg Fed in knA and Fad in wilt <br /> FEM <br /> Drivavay Fnanmchm d Pmnit berme fine—....:...._.......:... . <br /> 5JdWWecfion <br /> .. <br /> ywtorw/Opips.-... _ ❑Pavedfinratsga____:....:_._.....__S100.00+0.46/S <br /> ^SISS.00 El (Latta• <br /> Curb, ,sidewalk. --..__.-$Ioo:00+09878 <br /> Drivewayw/bos G�tlvat_._..................................__. <br /> CmmWCa*#m,cAAoeemkApplroation for PmmiWDayeway*ad Paved Frontage Page.2 of 2 Ravlaed W" <br />