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I. That he/she has seed all the pr<ivisions <br /> 0ffts appbeftbOM and Ova the descripbon a>Cvxm m em NAmLamm wa <br /> mu ua <br /> kmwhvdge;sad <br /> echo re§W=wt8"Wnrl*d <br /> 2: That hdsho is tho owner of tba respediva Pt'aPmtY Or is�R _ <br /> 3. That he/she will assaoio fall rasps SIC all&dgdy <br /> fr3rpason01 injury or damage to proPedy may arise out ofthe wodc dwct'bed above, <br /> orvyhichmay arise out of Wslhm'failure to do to wo&provided herasm;and <br /> 00 he shall <br /> 4. Thin the event any claim of s uh HabW y is made W'nd lleCQWAY of Sam ma Amo or any�,asst Or '0e <br /> at <br /> defend,mdam*and holdilmm and em b of them beanies fur such Claim;and <br /> 5. That wok shall be pafanned by the applica*and/or any:eMqeatative of the applicant in the Canty RWA-cf-Way at the above iadicaW site <br /> with a valid San Joaquin County Enamdimad Pemst and <br /> b. That if permission is gnrdai as regiusted,he agrees to do the war)c dela W is ac mbnoe wbh alt tmm oaod+=and eestrit ion of Orad suy <br /> attachad sbeet,included as <br /> Date <br /> FmmI1wFcroRCom <br /> EXERMIG COMMONS <br /> L DKEWAY: Nam l ❑ �+ ❑ Agamsift BM ❑ Paved(Good) ❑ <br /> 2.S[.OPINGe AFhd iaayfranPaves ❑ Tovw&Psvaemw* El <br /> 3.PB%S:• Now Efwft-TYPO <br /> Otbap4=iiknd9lmrbood: Yes ❑ No ApprwAm Cross Dram ❑ Sin <br /> Attw ma t io neigLboem Pipe: Yes ❑ No <br /> 4.HBADWAL L- Yes ❑ No" . <br /> 3.AmrALT cONCRE'E'E DHM-:, Yes ❑ No <br /> &BARREW ak"Rig wa* <br /> lh <br /> 9. DrKH Ya ElNo lfYa:• V style ❑ 2 Point ElP&w ❑ DV <br /> I.DFMWAY-. SFR CoMIAExCL4L ❑ A06CULTURIE ❑ INDUMIAL ❑ <br /> PAVED with. Z- bfO Dqe AC ova u Dep&3/4°A R <br /> • Nda <br /> 2. PIPI & L=&*of Pi p*Required:' Ft_mod Diu%Ow of Pipe inch <br /> To he oaaoeded to any AS di MMY NPe Yes ❑ No� <br /> DRAWAl3E WM REQUIRED Yes (� No <br /> Tabu I aagth (Vft tam) Total N=Wkr GCO60MMOrdE ifO <br /> Ndw <br /> 3. H ADWALL Ya No <br /> 4. PAVED FRONTAJgE: PAVED with "I&L Depth AC.over hfmL X 3/4"A.B. <br /> Maanuiag Fed is and Fed in width <br /> FEES <br /> Driveway Fnavadrmeot Paonk base fee _.._.. ... .585. <br /> on <br /> yw/a�w/o pipe.........._....._......._......_ _ El paved finataga.._..._...._...._....._....5100.00+4.46/R <br /> ❑ nriveway w/bos artvact 155.00 El cud),Ciera,siaewaur... —.----,-$100-00+0-98M <br /> CaumtalCaoupirter,o:1Hc«es4ApPliostianfor PecmimlDuynwsy and Paved Frontage PaBe.2 of 2 R evleed 8/2000. <br />