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1. That ha/slie has read all the provisioen of this appficatiM and that the dwmtfim included iatiris application ate con-ect to the best of his/her <br /> knowhslge;and <br /> 2. 'That he/she is they owner of the respocdve property,or is gWffiied to rqwesea d,ow,and <br /> 3.,That hdtiuo will assume fall cespatrsihilily fir all h abr'W'y Em parmad i*n or damage to property which may arise out ofthe work described above, <br /> or which=Y arise out ofWs&er Mum to do the work pr ovided heocin,and <br /> 4. That in the evert any claim of such liability is made againd 1beCrmnty of San kagim or my dTmtme4 olfxasl(w em*yeo thae4 he shall <br /> defead,indemnify and holdIlim sad each of them harmless for sorb d&un;and <br /> S. That wait shall be pe farmed by We aprpfim*and/or say repreaefti m of the applicant is the County Right-of-W y at the above iodic aced site <br /> with a valid San Joaquin Comely Encrood neat Pamir;and <br /> 6. That if pomuasian is grauted asre¢ueatecl,he agrom to do tine m&described is acoocdanco with all <br /> temus,oonditiona and r+osttictiaa afthis and any <br /> attached prova, lom <br /> o <br /> Sugmlmrr of.4pplic�t-T Date <br /> FIELD Il'ISPECTOR commjgNT8 <br /> »»»»»»»»»»»»»»»»»}»»WaS'i'MOC ONDMONS«««««««««««««««««««« <br /> L DRIVEWAY: Now ❑ pat Gkavd ❑ Aggregate Base ❑ Paved(Iwa) ❑ Paved(000d) ❑ <br /> 2. ST"Mc Awayfrom Pavement ❑ Towards Pavanrent Flat ❑ <br /> 3.' PIPEW Now h-- Exk*9-Type <br /> Otharphm in> bodmod: Yes ❑ No LCJc_ Approa&m 0 Cross Drain ❑ Size <br /> Attadonout to noig&Wo pipe Yes ❑ No <br /> 4. IIEADWAILL- Yea ❑ No <br /> S. ASP!lIALTCONCREfEDIIa►: Yes ❑ No <br /> 6..BARRffi2S atangBigh"Way <br /> 4. DTPCH You ❑ No IfYu:a: V Style ❑ 2 Fbint ❑ other ❑ Wift Deptli <br /> PERMIT REQLMUD g M<z««««««««««««««««««« <br /> I.DRIVEWAY: SFR BCI COMMMIAL ❑ AQRItUTUR$ ❑ INDUSTRLAL ❑ <br /> PAVED with .*WW Depth A.C.over mm.Dw&3/4"A,g. <br /> Now <br /> 2. ME& Len�hafPipeReiP PtaodDiouipieroMpe Irroh <br /> To be connected to any adjacentdriveway pipe Yes ro <br /> DRAINAM INERT REQUIRED Yes O No <br /> Total (whhP gmod) Turret Huu+mhw otSboaar Dnk Etdels <br /> Nates <br /> 3. HEADWALL Yes ® No <br /> 4. PAVED FRONTAgE: PAVED with ".MGL Depth AC:,over "Mn.Depth 3/4-A.B. <br /> Mpg Fad is kng&and Feet inwidth <br /> FEES <br /> Driveway Fnaoadimmt Permit baso fee._........._.._..... ... <br /> 585. <br /> ,field Inspection <br /> Mkivimay pipe..._....... _.__ _$95. <br /> w/ar'w/o ❑Pavedlmea........._.....:_._...,__....sI00.00+0.46fft <br /> ❑Driveway w/box Calvet—._._ <br /> ❑Curb,Clutter,Sidewalk..:.. ._....._.....$100.00+0.98/ft <br /> CountaiComputer,C.IV==Vfflioation for Parmits)Drivaway and Paved Finatago <br /> Page.2.of 2 Revised 8!1000. <br /> j <br />