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1. That he/she Las seed aH the provisioms ohms MPPbCXbM and that the ciesc rip M mem m mm-11'=a W ,..a.....a ... r <br /> krov►twdge;,� , <br /> 2: Tint he/sheisthe owns•ofdw respoctive proPmty.as is eptal ad too rgcesm t dootic and <br /> 3. That Wake wilt assamo fall VVfoe sett hasty iorpxsonai Wary or damage to property whichmay wise out oftheI work descz�bed above, <br /> or whkhmay arise out ofNg&or Mum to do The work provided hmm;and <br /> 4. That intbe event any claitn of sada babW is made gpiWt theCvunty of San Aoti qjm or any. ,offie sI or employm t be shall <br /> ddevA mdamnifyr and holdthem and each of them bam mess fes such ClainK and <br /> 5. That work shall ba pa&mmd by the appliic a*an&or may reprout ative of the applicant in the Corttty Ri&-of-WAY at tha above indicated site <br /> Wth avalid San 7oagWn Coady Enm oadrmeat Peach;amd <br /> 6. Thrt if permissan is granted as raq wted,be agrow to do the woz>r doaca'bed iascoardaaee vl4h`A teems,oonfdkms and tin afthis and any, <br /> dbr&d sheet,>ncdu led as geamd or special M proves iom / Q <br /> oZ/ <br /> FIELD R(WFCTOR COhffdRNTS <br /> ENIS MOCONDMONg«««««««««««««««««««« <br /> L DRIVEWAY: NOW Dht ❑ (3r+veel ❑ AggregateAmme ❑ P ) ❑ PavedO ❑ <br /> 2.SLWI NGe Avcayfrom Pivamu t ❑ Towards Favameot ❑ F1�a� <br /> 3.PIBES:• Now Eo sft-Type <br /> Otberpipasia� Yes El Approaches CcoesDsain ❑ sive <br /> Attar ma t to newihoes Yes ❑ No <br /> 4 BR4DWALL: Yea ❑ No . <br /> AStSALT t 1oPPC mz Dm:? YmY_as ❑ <br /> 4..BARRMN ak"Riglto&Way <br /> 9. DrK H Yes ❑ No IfYeo: V Style ❑ 2 Pbint ❑ O&w ❑ Width Depth <br /> <z««««««««««««««««««« <br /> 1.DHMWAY: SFR COMMS.=AL ❑ AGRtCEILTU" ❑ INDUB IAL ❑ <br /> PAVED with. R WW Depth A.G.ova. _ "JJm.DWlh 3/4"A.R <br /> Naga z�X y/ GsDG CU,C$ <br /> 2. PIPM I A*b amm Regaiioet Ft and Diamaieeer of Pipe inch <br /> To be.aomecyed to any afjaoant ddvemy pipe Ym ❑ No <br /> DRAINAOE TMST REQUIRED Yes D No <br /> Tots l Length: (with pmpoeed) Total N=mWkr of 9bam Drabs Weds <br /> Ndas <br /> 3. HEADWALL Yes 0 No <br /> 4 PAVED FRONTAt;E: PAVED with "Mm.Dep*AG aver "Mur.DepdL 3/4"AB. <br /> meaatring Soot in and Feet in width <br /> FEES <br /> Driveway Faeroachmeat Permit base See ...:...:._.. <br /> Freeld[nspecfian <br /> ❑Dcivemya/or w/opipa......... __ 3.95_40 .[�Pavodfioat+rga.--...._:_._—...._....s1�.46/$ <br /> ❑ Drivewayw/boaC�r1veR_....._............_...._..:......_....sisS.Of?. t�C�b.Qo16nr,8ide�:.:_............... 100: <br /> CarmtaCCmWutw.c-VwceselFlpptiostio ,far PamWOamemy and Paved Frumt p PAW.2 of 2 Ravlaed 8/2000. <br />