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I. That he/she has read all the pruvisiaans of this Whcsho%and that the descxi b n ahcloded mean aPP"a are QonT.*x w u a�.�.•••.-..a _ <br /> iMOwhvdge;and <br /> 2: That he/she is the owner of the rive Property,or is gaaiified to rpt the owar,and <br /> above, <br /> 3. That he/she will*890m fall reapca itY for ail tiabililty farpawwl injury or damage to property`���`arise out ofthe wodc described <br /> or which nhuy arise out of his&er fs&M to do the work ptoaldad and <br /> 4. That inthe event an+caitn ofsuchl d"ty is made ag+iest ffieCoamty ofSaokaomor any ,OMOW or coployeegymt he shall <br /> fid, and holdthem and each of thmh haaudassfor such da*and <br /> S. That wodc shall be pmfonued by the apphca*andlor any of the applicant in the Conmily Ri81rt-of-Way at the above indicated site <br /> wllh a valid Coasdy Fiu�aoent Pem�=d <br /> 6. That if as 1a agrees to do the work dwm*ed m accardaaoe with an tis,ocodatir3os and tost�idiaa offltis any. <br /> attached t as general or IIl provemona3. ,- <br /> Sigma Tito <br /> FIELD INSPF�C MR COAMENTS <br /> EXISIMqGCONDrrIONS <<<<<<< <br /> DRIVEWAY: <br /> F2. <br /> None Olt 13 C MI d 11Aggv8Ma Hese D Paved(POW) ❑ Pa° d°0d) ❑ <br /> SGOPINGe AwayfromPmaina>t ❑ TowardsPavaaneat Flat ❑ <br /> 3:PIPES:. Noss Egg-TYPO <br /> Odmrpipes in>aigbboshood: Yes E] No Appnoaclas 0 Gtues Drain ❑ Size L <br /> eatto neigblroa"a pipe: Yee ❑ No <br /> A.HEADWALL: Ya ❑ No <br /> S.ASPRALT CONCRETE DACE: Yes ❑ Na <br /> &BARRIERS ataegRigbt-o&Way <br /> 1.DOM Yee ❑ No IfYes:• V Style El Foint El Other ElWith Depth <br /> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Pg�� M««««««<<<<<<««««««« < <br /> L DRIVEWAY: SFR ❑. COMAEACI L AGRICULTURk ❑ IIV umlIAL ❑ <br /> PAVED with. "Wa-Depth A.C.over. ( "Wm DslA h We AJ <br /> Now <br /> 2.PIPE& L n8*of Pipe Realoired:• FL aad Di n*w cf Pipe inch <br /> To be connected to awry adlaoeat ddvevany pine Yea ❑.2Qo� <br /> DRAIKAOE INLET REQUMM Yes O No <br /> Tolal Length: (with Proposed) Total Number etE Stena Dradis Inlets <br /> Now <br /> 3. HM&DWALL Yes no No <br /> L PAVED FRONTAq& PAVED with "Mm.Dep*A.C.rawer "Mar_Depth 3/4"AB. <br /> Mpg Feet in keg&and Feetis width <br /> FEES <br /> Driveway Faanachmes t Pamir base flee . .:...:. .. ...: <br /> FeldhmpecNion <br /> ❑ Driveway w/or w/o pips......._ ❑paved <br /> . <br /> El (haMurlB ..$100.00+09 <br /> CcuffiaiCompirter,c:tAoaaatAppiioationfon Pacu>WDay way and P�Frew Paga.2 of 2 llevl$bd 8l'1000. <br /> IN <br />