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1, 11MC UW RM nen Boma an Um rxar <br /> rsaanxs vs.+m.y +s�uaoc ua wcav[syra.w,.w=w+..-..----—rr�'_—'••,••••••,••••••••••�••••"•••••.•••• ••••••--- '" <br /> knD and - <br /> 2: 'That hdahe is the owua ufthe reVechve property,ar rs grp&Wiedto repccsmt the owl and <br /> 3. That he/she Wil sesame W rapaahs+ il9 foe ail�Y forpasonal injury or�e to ley vl 'woo out afthe wudc descabed above, <br /> orwhich may arise out of h.&w failure to do ffia wo&Vrovided havia;and <br /> a <br /> de g+iedtbeCoady of Satin 7oacpaa or MW o�or empbyle8 he shall <br /> ` 4. That iatbe avant any claim of sadt�ebs�'y is ma• <br /> did,kdemniijr and holdthem and each of them hem lm Sor Awh ds'M and Wa at the above indicated site <br /> S. That work shall be pa boned by the applicapt and/or any represe»tffiiive of the applicant in the Coady R+8d'd' Y <br /> with a valid San 7oagain Coady Fmoac meat Pm*and <br /> b. Tthht if permisaian is wanted as reVed4 he agrees to do the wade describedmacacrdaoce vah all teahm,oonditi(m and restriction dd*and any. <br /> attachedahead,' provmons. _ .9 <br /> ' 8ighesertr <br /> Tide baba <br /> FIELD INSPECTOR.CO11d1161FdM <br /> MaSTRZOCONDMOWNS«««««««««««««««««««« <br /> L DRATWAY: Nam Dict ❑ t3ravd ❑ AMegate Base ❑ Pav_kpoar) ❑ Pav*Oood) ❑ <br /> 3.5�,OPINGe AwaySrom Pavament Towards PaV maht ❑ Flat ❑ <br /> 3.PIPES:. NOW E -TYPO <br /> Otherpipes inneigbbodrood: Yes ❑ No Approar]hes C.Drain El size <br /> Adacbmau t to ne&oes Yea ❑ No <br /> 4 HEADWALL: Yes ❑ No <br /> S ASMALT CONCRM DEM.' Yes ❑ No <br /> 6..BARREMS a�*V RWA-& ►ay <br /> 1. DITCH Yes ❑ No Wye, V Style ❑ 2 Point ❑ 06W ❑ Width <br /> Depth <br /> »»»»»»»»»»»»»»»»»»»>>PERWr-RgQUMEMENTg<z««««««««««««««««««« <br /> L DRIOEWAY: SFR COs - ❑ /AGdCULTURJ& ❑ INDUffnUAL ❑ <br /> " <br /> PAVED with. Edtio Depth AC.over. �T "h6u Depth 314"A B` <br /> . NQes <br /> 2 PEMEk arpip R-Fko&. Ft.and Diu**w of Pipe Inch <br /> Ta be.aomectedto�aya soentdtivevvaypipe Yea ❑ No <br /> DRARIAOE MET REQUMED Yes El No <br /> TOW LW* (with proposed) Total N=ubw e[SMM:Drak bdefa <br /> 'NdAs <br /> 3. iiI "WM L Ya © No <br /> q. PAVED FSONTA�E: PAVED with "d fi,Depth A.C.Ower "bfm.�3/4"AB. <br /> Feet iaa grad _Feet in width <br /> F7t;FS <br /> Driv Fnavac>hw aflt PmmA base flee—...:...:._.._.....� yy <br /> away `�, <br /> Fieidln"&,on <br /> tivawa w/as w/o _— � 5 ❑Pavaifi'aat g&___:...__._..___SIOOAO+0.464 <br /> ❑ Dr veway w/boa Calvert_._. __. .._.. _. . SiSS_00 ❑Calk Gutter,SWcwallc...:......:....—...5390:00+0.9815 <br /> Revised 812000 <br /> C » ,,pihter,c lAoaaaVVOjwAmhf r P yeway an Paved Froatags PsV.2 of 2 <br /> autai <br />