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THE A1?P1AUA6N'1'B-LKLM Y. UJLK1ar iba: <br /> 1. That he/she has read all the provision of this appficsfice,and that the deseription incuded inthis application are coned to the best of hisAw <br /> kwwhpdMand s , <br /> 2. That he/she is$e owner of the respective prgmty,or is qualified to represent the Owner,and <br /> 3. That bilabe will as==fall reipousdbility€or all Y far perscoai iajmy or damage to properly which may arise out ofthe work described above, <br /> or which may arise out of his/her failure to do the work ptvvided haaiv;and <br /> 4. That in the evat any claim of sack liability is made against RoCoudy of San Asad or guy department official or employce therao&he shall <br /> defend,indemuii'y and hold them and each of them harmless for such claim and <br /> S. That work shall be pedbrated by the appheW and/or any of the applicant in the County Rightof-Way at the above indicated site <br /> with a valid San Joagain County Facroadhmeat Pemhi$and <br /> 6. That if pmmissim is grouted as requged,he agrees to do the work described inaaoardaace withalp temps,oaoditims and reskiction ofthis and any. <br /> attached shed, as general12(1 /0(, <br /> or III <br /> SigoatmeofAppZ Till- Date <br /> MUM INSPECTOR COMMENTS <br /> »»»»»»»»»»»»»»»»>}»»EXISTIM CONDMOM««««««««««««««<«««««< <br /> L DRIVEWAY: None ❑ out (hovel ❑ Amite Base ❑ Pav*Pow) ❑ Paved(Good) ❑ <br /> 2.SLOPING: Awayfmm Pavaoaent ❑ Towards Pavama st ❑ Flat [ <br /> 3. PIPES:. Now Emoting-Type <br /> Odw pipes iu nei�1: Yes ❑ No Approaches ❑ Ckusa Drain ❑ Sim <br /> Aftadhma t to neoighbor'a pipe: Yes ❑ No <br /> 4.HEADWALl- Ya ❑ No . <br /> S.AS'l'SALT coNCRSTL num., Yes ❑ No, <br /> 6..BARRIERS al wWftht c&Way <br /> 7. Drrm Yes ❑ No IfYes:• V Style ❑ 2 Point ❑ Other ❑ Width Depth <br /> »»»»»»»»»»»»»»»»»PERMITRRQUIREMEN'i'S««««««««««««««««z«««< <br /> L DRIVEWAY: SFR COMMERCIAL. ❑ AQRII(O-M )It ❑ DIDUSTRIAI. ❑ <br /> PAVED with "Mtn.DepthA.C,over �i"Min.Depth 3/4"AA <br /> Nates <br /> 2. PrP$& Langlh of Pipe Ragas Ft.and Diameter of Pipe Inch <br /> To be caoueded to my Aacaat driveway pipe Yea ❑ No— — <br /> DRAMAM INLET REQUIRED Yee ❑ No <br /> Toad Oft Proposed) Total Naaaier of Sturm Drift Ikkft <br /> Niles <br /> 3. HEADWALL Yes ® No <br /> 4. PAVED FRONTA GP&: PAVED with "Mm.Depth A.C,over "hfm Dap&3/4"AB <br /> lYlessaring Feet in lend and Feet is width <br /> FFM <br /> Driveway Faaowhn d Pamit base See........................... <br /> FaidInspection <br /> y w/or w/o pipe ....._ __. ._ _ _ ❑Paved fiamtage _ _ ., _. _ $100 00+0.461S <br /> ❑ Drivoway w/hos Calvet_. .. _ ........ .. _..... 5.00 ❑Chub,Clutter;Side�vatk.. ..........$100.00+0.98d <br /> Coanterl xltw.c:lticc=VVpleost=for PermitzZWymay and Paved Fina>tage Page.2 of 2 Revised 8/2000. <br /> \: <br />