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1. i1,1�RL J1i,WLV arw nam,as uYo r/(Vrao,V„e W.YM.•yy+�!""""'+""` + .. <br /> dMowlW8a;and <br /> or is gnaTafied too i'CQf�L#�10 flw11D["?fes _ <br /> 'Z: That dxefsh0 is9ie owner of the tespedrve L"`z"`» whi&nay aria,t�oftbe work described above,3. Tbat h rake will aseame full raaPan�ity far std l AALty f3orpenomi�or�e ` <br /> arwhichrnay arise ant of b.Iw faidme to do the waakprMWWhavim and <br /> tbaba�be shall <br /> 4. That in to event any daim of such Nabaa ft 's ffi made aga�st t3raCouuty.-San or '° or <br /> de fend,mder *and hold hem and ends of them mania for sick cheim;and Wa at the above indicated site <br /> S. That wads sme <br /> hall be pakd by the gVHCW and/or say remm,.Aw of the apQlicasrt in the County RiBbt-of- y <br /> wbh a valid Sas Jaaqum CoMPY b macweot Pewid,sad wirlaaldtemra,aoodWom and reskiotian d*b and any. <br /> b. That if permission is ERmted as re4 'be IBM'to do the wadc desmbed m acoardacaoe <br /> attached dwK nwhided w.gwxai or spe`xad III pavv ' <br /> Data <br /> sip%tw&ofApp i-1M1- M& <br /> FIELD IKSPEiCTOit 00 <br /> »»»»>»»»)»»>»»»»»»}»»��Q CONDMO B«««««««««««««««««««« <br /> Qava AgM811HPa <br /> vexpeor) <br /> FILgitEWAY: Nas Flat <br /> 2. LOPING ❑ <br /> Aiwyfn=Pavameot ❑ TowacdsPavaareast ❑ <br /> 3.PIPES:. Now Exkft-'dope <br /> Other Pipes in <br /> Yes ❑ No Approaches 0 Crum Drain ❑ Size <br /> Attacbma t to nom's pipe: Yee ❑ No <br /> 4.ggADWALL: Yea ❑ NoAa <br /> 4S <br /> S.ASPHALT CONCRETE DIKL►:' Yes ❑ No <br /> &MRR=9 ak"RW-o&WaY <br /> 1. nrrcla <br /> Yee ❑ Not lfYes:• V Style p 2 Point ❑ 91bw ❑ Ww& -- Dw& <br /> »»»»»»»»»»»»»»»»»»PERMIT RBQumEumm <br /> L nRlvEv�AY: SM �--� <br /> dJOMMERCL4,L p �' ❑ IIVDUSTRIAI. El <br /> PAVED with "Dept A C ova �_ Min Dep<3a 3/4"A 1L <br /> Nates <br /> 2. PEM& Im**of Pip Ft sad Iliama6er aF Pipe Ineh <br /> To be cooneated to any adjaoarrt driy"wY Pipe Yes ❑ N, 797 <br /> DRAINAOE INSET REQUIRED yea No <br /> TOW Imugth: (wi h pmPm* Total Number et Stam Drda Iideft <br /> Notes <br /> 3. HFADWALL Ya ® No 49 <br /> 4. PAVED FRONTAgE: PAVED with "Mm.Depth A C.over "Mer ibPth3/4"Ali <br /> Feet is le"6 card Feet in width <br /> 1�F.8 <br /> Driveway Fnaoscbmeat Permit base fee_....................... <br /> Fief bwecdm 510000+0.46/& <br /> 5300:00+0.98/& <br /> ❑ Ddvemyw/box(�alvect _ _ S155-00 ❑Cuff.Cicktar,Sida�vadlc _. <br /> .� par-2 of 2 Revised s/z0o0 <br /> CanntealCompirter,c: kApplioafm for Pens 1�Driynaay and Paved Prnatar <br />