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I. Ther he/she rasa rew at►the provwow or mis anu war um a escr4m a na Twou <br /> krowlwdge;end <br /> 2. They he/she is the owner ofthe respective property,or is gwdified to reprtsml flee owney and �. <br /> 3..That Wake will assume fall roily firr alt lia w FOrpe(somi=jury or damage to property whichmay arise oat ofthe work descuIed above, <br /> or whichmay arise oat of Wafer hilum to do the wadeprovided hernia;and - <br /> 4. That in the oval any claim of such liabi ky is made agaiBstt iheC unty of&m Am li m or an.y depwimeA cfCial or employee thav4 he dun <br /> defend,made*and holdt am,and each of themhamadess for such claim;and <br /> s. That watt shall be pmfonned by the applicant and/or say moire of the applicmt in the Coady F.igWof-Way at the above indicated site <br /> w1 h a valid San Joaquin Coady Fncmroachmamt Permit;and <br /> 6. That ifpsmisam' is roquested,the agrees to do the work described iaamwdanoe with all teurA oonditions and rem ofthis and any. <br /> at�hed p� <br /> . . <br /> Signora Made <br /> FIELD 114STECTOR COAffd;M <br /> »»»»»»»»»»»»»»»»> »»>BIflSTINO CONDrMN8«««««««««««««««««««« <br /> L DMt WAY: Nape Oat ❑ Onvaei ❑ Aggregate Base ❑ P+va%Mw) ❑ Paved(Good) ❑ <br /> 3.SLOPINQ Awsy&am Pavament ❑ ToW&nls Psvamaot ]" Flat ❑ <br /> 3:PItF.S:, Nome E -Type <br /> O&wpipwinneigbbodxxxk Yea ❑ No AppmecLes F-1 Cross DW, ❑ Si, <br /> Attar ma tto ne~Pipe: Yes ❑ No <br /> 4,HEADWALL: Yes ❑ No <br /> ASPRALT OONCRETE 13M.-� Yes ❑ Na , <br /> &HARREMS akwORW9c&W4 <br /> 1. DrM H Yee Wye - V Style ❑ 2 Point ❑ Od., ❑ Width Depth <br /> PER.MITREQU EMENI s«««««««¢«««¢««««««««« <br /> 1.DRIVEWAY: SFR Wb I,011L ❑ AGRICULTURk ❑ INDUSTRIAL ❑ <br /> PAVED with. 'Z— "I1 Depl>l A Q over 4 Mia.Depth 3/4"AR <br /> • No'es <br /> 2..PH!E& Ft.sad Disaster of Pipe inch <br /> To be oaaoected to any afaoeat dhiveway pipe Yea ❑.N% <br /> DRADWE INLET REQUIRED Yee No <br /> Total (Wkh p mpm* Totel<Nauber of ftemna:Drahh bdets <br /> Nates <br /> 3. HEADWALL Yes © No <br /> 4. PAV®FRONTAGE: PAVED with "Min.Depth AC.ower "Mw Depth 314-AB. <br /> Mastu'ng Feet in hugth and Feet in width <br /> FFAS <br /> Driveway Faawwhn nt Permit base fire_. ..:..:....._.. <br /> Fieldlnspection <br /> ❑ Driveways/ars/o pips_....._ _ 595.00 Paved _. ___ _5100.00+0.46/8 <br /> ElDriveways/boxGlntveat._._ _ _ .._ ._ - SIss-00 �,sidewaIl� 00 <br /> Ca mftw mPuter,o:lAcccwVVpliaation fir PeEn WO#yeway and Paved Frontage Page.2 of 2 <br /> R eviabd MAN. <br />