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. uw�uvraww"vs uua E'!a"^w+*si osav uawa we uwta�yeawa+ua,=w...m...�, <br /> kwwt dge;and t r- <br /> 2: That ltdah0 is The owner Of the i+espOdive t"i atys oras qualified . <br /> 3..That he/sha will=sum&( or All fidik <br /> owl� <br /> of whioh may arise oat da the waalc provided hetet aad� to PAY vvfsioh may arias out ofihe work described abovq <br /> 4. That in tho evrat any clit,,f wh tiab-My is meds apsa he "Um <br /> da ea4 indemaify and holdthem:and each of thmt hsmjew for each do*d °¢M9.devotment affidat or y"&wwt he si�Il <br /> S. That work shall be Pedocmed by the appy amd/as <br /> with a valid Sam JoaquinComely F represemktiVie ofthe applicant in the Cot*Rigbt.of-Way at the above.indicaLed sifa <br /> wd <br /> S. That ifpwnission <br /> shed shoot,bAkWod as as be M. w deaarbed is scoaadauoe with alt terms,teams and rvsWctiM afthis amd any. <br /> . awal or <br /> I?aibe <br /> »»»»»»»»»»»»»»»»»»F>j�gXlg'iIl�RICTOH(OMN[Et g <br /> t COND11T(Ng«««««««««««««««««««« <br /> L DRI�LWAY: <br /> None ❑ Dut ❑ Gmv6l ❑ BaseF� <br /> ❑ ❑ <br /> aved(poor) y i <br /> 2.SL 0PJ NQ Av-yfmm Pam ❑ Towaarls Pavaoti� ❑ Pa�OOod) <br /> 3:Pl1'EB:. Nate A 8-Type v "' <br /> t pq:es tonUm% <br /> e g °od Yes ❑ No ApppmwchmQ CMM Drain <br /> 0 size <br /> pqy <br /> Aim Yes ❑ No <br /> 4 HBADW Yes ❑ No, <br /> S ASPHALT C+ONCRM DM._, Yes ❑ No <br /> 6`.BARRECRR ak"RW -a&Way <br /> 1. DITCH Yue ❑ No <br /> IfYas:• V Style ❑ 2 Point ❑ Odw ❑ WidW <br /> »»»»»»»»»»»»>>>>>>ppRMTi' <br /> 1.Dgn,EVlfAY- Q i REQUMEl[ENTB«««««««««««««««««««« <br /> 8FR `Cys. <br /> �Mh'"CL4L ❑ ACX LTUU ❑ <br /> INDUSTRIAL ❑ <br /> PAVED with. Z ..+hfi&Depth AG <br /> Nates lldm.DV&3/4"All <br /> 2. PIPM LsnSq►ofPips iced <br /> ---__Pt and Dish otpips filchTo be ooaitected to any adjft�rivievgty Pipe Yes ❑ — <br /> DRAIIdAL3E INSET REQ;TIBgI) Yee No ( � <br /> Tow *- <br /> (veil ) Todd Number 9fS16esse:Drm t <br /> Nates <br /> 3. MLkDWALL ya No <br /> A. PAVED FBONTACE: PAVED with <br /> " Dapth A G over "34ia DepBa 3/4"AB <br /> Massur� Fast in length and <br /> Fast in width <br /> FEES <br /> '?LvOvaY meat Permit base fee�.....:..:.........: .�. <br /> ,F_.i,�W lnspe on <br /> tayoz/ar w/o pipe.......... ........._.. <br /> ❑Drivewayw/boa(�r1veR _ _ _Sg5_ ❑Pavadit�------ _ $I0000+o.4618 <br /> out Curk Gter;.sidewally..,:_.—.-.._...-$iOo:0o+0.9818 <br /> �a�Canptrta'c'�o��PP�bicn for PAY and Paved Pmnta$e <br /> Pa8e.2 oft RevWd8120o0. <br /> • r <br />