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't'HL''AYYLiF,j9►.:v JL n n,tcr.n i. ..r ni u•••,.r• ma MW in*is,application are correct to the best of his/her <br /> I. That he/she boas read all the provisions of this application,and that the description <br /> ription <br /> knowhrdge;and <br /> 2. That helshe is The owner of the respective property,or is qw Med to"preaau the owr�and <br /> 3. That he/dse will Asm*ne fall responsihility for all lishiiity forpasanal inincy ordamage to property W"May arise out of the work descdbed above, <br /> or which may arise out of his/her failure to do the work provided hecein;and <br /> 4. That in the event any claim of each liability is made against t$eComrty of San&iagian or any del>srt ,CMCW or employee thawt he shall <br /> defend,iodemaify and hold them and each of them halm lam for such claim;and <br /> S. That work shall be pefarmad by the applics*and/or any repave of the applicant in the Couady R.i*'of Way at the above indicated site <br /> with a valid Sera Joaquin County Fncroecbmerd PrmsiN and <br /> 6. That if is graded as tegiaested,he do the vuark desc ed in acoordance witls all teals,000dWans and trstdcticn ofgh s and any <br /> g0ached as gene�l�r lu ,� .� �2�f t'�� <br /> -,a Date <br /> FIELD INSPECTOR COBOdautTs <br /> g)aS11}CONDMONs <br /> L DRftWAY: Now ❑ Dict Qmvel ❑ AggrepteBase ❑ PavckPw) ❑ Pa�Cood) <br /> F ❑ <br /> 2.SLOPING: Afrom Pavement ❑ Towards Pavement ❑ Flat <br /> 3. PIPES:. None Eaifg-Type <br /> Other pipes is neighborhood: Yes ❑ No App vachea Cores Drain ❑ Sim <br /> AftadsmenttoneigUms Yes ❑ No <br /> 4.HEADWALL: Ya ❑ No <br /> S.ASPHALT CONCRETE DIEM-', Yes ❑ No <br /> 6..BARRIERS slang Rrgbt-oWay <br /> 7. DITCS Yes ❑ No Ifyes:• V Style E] 2 PointElOthw El Width Depth <br /> 1.DRIVEWAY: SFR ❑. CObt1dERCIAL AGRtCULTUR9 ❑ INDUSTRIAL ❑ <br /> PAVED with 7i "Mk.Depth A.C.over �;"ld DW&3/4"A.B. <br /> Nates <br /> 2. PIPM Length of Pipe Regairod: —�—� Imch <br /> To becoaoededtoany adjamatdrivewaypipe Yes ❑ No Q�l� <br /> DRAINAGE INLET REQUIRED Yea ❑ No . <br /> Total T,ength:. (with propoeed) TeW Number of St♦►ran Drda Islets <br /> Nates <br /> 3. HE DWALL Yes r No <br /> 4. PAVED FRONTAGE: PAVED with "Mm.Depth.AC.over "bf n.Depth 3/4"A.B. <br /> g Feetin ie"Oh and Feet ffi width <br /> FEES <br /> Driveway Faanad>nxwt Permit base five_....................... . S. <br /> ��Fia/ld��hsp <br /> ' ection <br /> L4hveway w/or w/o pip er......._ .__. ._ _ .._ S95_ ❑Paved t ge—. _ .___ ..__ SI00 00+0.46/S <br /> ❑ Driveway w/box Cwtvert.___ _ ........ .._ .. ..... _.SiSi.00 ❑Curb,t3uiter,Sidewalk.........:........,-$/00.00+0.98/ft <br /> Coudaw,amputer,c:kAocesalApplication for PermWDdveway and Paved Frontage Page.2 of 2 Revised 8/2000 <br /> i <br /> t.� <br />