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i. •t'hat tte'stte 1�rasa an tsa prvvxicvam us wm aj,�ur�w,cuay,ave u�c►u,v acaca�rercau,.s..,....r..,a..,�,.zl......................�............_----------- <br /> kwwlwdge;and ' <br /> 2. That helshe is the owns of the respective property,or is mod to repcesant the owner,and <br /> 3. That he/she will assamo Sall req mslility for all hdxTdy 6hrpmmnai injury or damage to property whichmay arise out ofthe mark described above, <br /> or vvhichmay ansa oat of W lfwr failure to do the wank provided her ;and <br /> 4. That m the eva t any claim of muh liabaility a made agawst lb*Cm dp of SanAmq-mor=y&pwW&e4 afcisi or employee the ha shall <br /> ddaad,indemnify and holdthmn and each of them b miesa far such claim;and <br /> S. That work sball be paformed by the apphca*and/or any repre adative cf the applicmt w the Canty Rigbi*of-Way at the above indicated site <br /> with a valid Sart Joaquin Candy Encroacbmad Penahit;and <br /> 6. Mmt if pmmiss m is grated as requested,he agree to do the work descaW in acoordanoe wi h all tonna,000ditioms and tashiatim of this and any <br /> Sigoet<utr afApplicard-Tilts Da(W <br /> FIELD INSPECrOR COBBORM <br /> »»»»»»»»»»»»»»»»>}»»EKIS'iMO CONDITIONS«««««««««««««««««««« <br /> L DRATWAY: NOW ❑ but ❑ ciravd ❑ Aggregate Base Q Paved(poor) Paved Gwd) ❑ <br /> 3.SLOPINQ AwayEroPmaa t � <br /> m m Towards Pavammmt ❑ Flat [] <br /> 3:PIPER:. None 0n(wft-Type <br /> eDyftj W ) <br /> Odwpipesinndghborhoo& Yes arxo n Apps.,.. k Cww Dram ❑ Size <br /> Arent to neighbor's pipe: Yes ❑ No <br /> 4.K ADWAL. Yea ❑ No' <br /> 5 ASMALTC�ON�CEtEF6DtY6:� Yes ❑ No <br /> &BARRHM ak"R*to&Ws* <br /> 1. DrwH Yee No ❑ if Yes:• V style 2 ❑ O&W ❑ Wirf Dep9t <br /> <z««««««««««««««<<«««« <br /> L DRIVEWAY: OR - ----- Q AGRtCMTLYR9 ❑ INDUSTRIAL ❑ <br /> PAVED with. ?i "11dm Dep@h A.C.ova _4 _"Idiin.Dep6r 3/4"A.B. <br /> Nates <br /> 2. PIPE& Lahsth ofPare Rorkcd FL and Diameter of Pipe �. Inoh <br /> To becamoectedtoany a4wWdidvovmaypipe Yes ❑ No <br /> DRAIhiAM 1NIE'P REQUIRED Yea 0 No <br /> Total L IOL (wkh p mposed) Total Naber et8tom Dedra Italeta <br /> Norms <br /> 3. HEADWALL Yes Q No <br /> 4. PAVED FRONTAGE: PAVED with "Idem.Dapfh A.C.ova "h im.Depth 3/4"A.B. <br /> mmaurimg Feet is tength and Feet in wriddL <br /> MRS <br /> Driveway Enaeacnment Permit base fee _......._.._...:..4 S85.OQJ <br /> old[nepectian <br /> yw/orw/opipa.......__-...._ _ ❑Pavaedfinaga._ __..._...._....s100.00+0.46/& <br /> ❑ Ddvewayw/bos antvnR_.�__ _ . ..._ �slss oo ❑cud),cluttw,sidawaIL- _._..........sloo.00+0.98M <br /> CauntalCommpiter,c:lAoasslApplioation for Pa�ffi1Dniy evmy and Pawed Frontage Page.2 cf 2 Revised 8/2000 <br />