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_-- <br /> kmWbWM and <br /> 2. Tbat helshe is the owns ofthe respective property,or is qualified to represent the owner;and <br /> 3..That helahe will assume fall regmsMity for all Hgx&Y for Personal Wimy ordamage to pmpcaty which may arise out oftho work described above, <br /> or which may arise out of hisdier Mum to do dee work p raided hmvnn aced - <br /> 4. Mut inthe cuntany ciaimofmachbabdrtyismade against 1heComlyo[San km4,m orsnydepeatmert,ovistorenploymdwreo&heshall <br /> defend,indemnify and hold*=and each dthemhamdmafwan&do*and <br /> S. Mut work shall be pedocmed by the aMhca*andlor any represestathv of the applicant in the County Rightof--Way at the above indicated site <br /> wide a valid San Joaquin County Fmnadrmpnt Pemtifi and <br /> 6. Thd if pemmissien is granted as requested,lee•agrees to do the wads described inacoordanoo witha ff temps,eonMom and restriction ofthis and any <br /> attached sheet,inchxdedd asxal ape c oviaico$. <br /> FIELD IRISPECTOR C011RAENTS <br /> EXMTU'fGCONDTTidNS««««««««««««««d««««<<< <br /> L DXtWWAY: Now Dict ❑ Oravael ❑ Aggregaft Base ❑ Paved(poer) ❑ Pavak0ood) ❑ <br /> 3_SLOPINGe Aigayfrom Fkvamant (] TowudsPawrvmt ❑ Flat <br /> 3:PIM:. Now �{6J� E -TYPO <br /> Odmpipm in neiekoshocd: Yes ❑ No App vachw ❑ Crm Drain ❑ Sian <br /> AttachOeenttoneLirar4 Yes ❑ No <br /> A.HP;ADWALL: Yes ❑ No' <br /> 3.ASPHALT CON+GHETE DZ>ita:j Yes ❑ No <br /> &URRIERS ak"RiglA_o&Wsy <br /> 9. DITCH Yes ❑ No lfYes:• V Style ❑ 2 Point ❑ O&w ❑ Widtle Depth <br /> <z««««««««««««««««««« <br /> s<DRIOEVPAY: SFR - COMAE, ❑ At;RWMTMI ❑ INDLUMAL ❑ <br /> PAVED with. .."Mam,Dep@►AC.over _-"Afin,Depth 3/4"AIS <br /> Nates <br /> 2..Pu?m Leh FL and Dismaier of Pipe Inch <br /> Tobe.00mectedtomyadjacent driva%Wpi" Yea ❑.No <br /> L)RAIL�IA¢E INSET REQUIRED Yea ❑ No <br /> road u%&- (veith proposed) Total Ntaeier oaf Stnist,I)nk Imeft <br /> Nates <br /> 3. EMADWALL Yes © No <br /> ci. PAVED FRONTAGE: PAVED with "Mm.Dw*AC,overmasuring "3Sm Depth 3/4"AB <br /> Featinteashand Fed in width <br /> FMIRS <br /> Drivmay Emvachmmt Permit boo flee .:. .......... <br /> : ._ <br /> f!JdWspeofion <br /> O'QiVefty w/or w/o pips_..._ _ S9� ❑Paved +0.4618 <br /> ❑Drivewayw/bosCk�lvatt ._ _.... _ .. Sd33.00 ❑Curb,Gutter,Sidewalk.........:.........,$300:00+09878 <br /> CMOaiCampitar,c:44ccemlAppliosLien fes ParmitslDdyaway and Paved Frontage Page.2 of 2 Revised 8/000. <br /> 1\• <br />