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1. That hee/slte has read all the proviso of this applicafiop,and that the description hwhMed in <br /> - this application,are confocd to the best of his/her <br /> knowtwd M and <br /> 2. That lie/she is the owner of the respective property,of isqualified to ngxraent thaownor and <br /> 3...That he/she will assamo full runty fcx aU lid,hrpwKnd injuryordamage to property w1kichmay arise out ofthe wadc described above, <br /> or which may ariseout ofhis/her failano to do the workprovidedherein;and <br /> 4. That in the eva t any cleitn of such liabMy ismade agaimt tfieConody of San Joagiun or ashy Official or employeathereog he shall <br /> defend,indem and holdthem and each Of theme hams for such clairq and <br /> S. That work shall be penbnned by the applicant and/or any representative of the <br /> applicant in the Comrgdy Right-of-Way at the above indicates site <br /> with a valid San Joaquin Coady FAwcachment pemfit and <br /> 6. That if permission is granted as requested,he agrees the wo&dosmlW in a000dance with a!1 <br /> teamts,conditions and trstricdion ofthia and any <br /> attapMd duvet, as ge ncrai or apocial In <br /> 3ismaho-of cami_Tifton D <br /> ate <br /> FIELD RUPECTOR COM1idENTS <br /> L DRIVEWAY: None ❑ pint GMV49 ❑ Aggregate Base. ❑ Paved(poor) ❑ Paved(004 ❑ <br /> 2. SF"ING. Awayfmm Pavauant Towards Pauemant ❑ F7a! ❑ <br /> a <br /> 3. PIPM. Now ❑ Exiaan8-Type Z ASC Zp� <br /> Otherpipes nnneiYes W No ❑ Approaches 0 - Cross Drain ❑ Sim <br /> Attachment to neighbor's Yea ❑ No <br /> L DWALL- Yes ❑ No <br /> S. AMEMLT CONCRETE DID1E: Yea 0 Na <br /> 6..BARRIERS along RigW_c,&Wsy <br /> 7. DUCK Yes �Cl— No Q IPYos:• V Style <br /> HEAPoint p O&w ❑ WW& <br /> Depth <br /> »»»»?»PERMITRFQLIIItEIdBNTS«««««««««««««««««««« <br /> 1.DEMEWAY. SFR COMMERCIAL, ❑ AGRtCFJLTURE ❑ INDtJST12IAI. .❑ <br /> PAVED with fj .."Ifin.Depth A.C.over ¢ "1.Depth I A.B <br /> Nates <br /> 2. PIPM Long1h of Pipe Regrriae& FL and Diem"w of pipe <br /> Inch <br /> To be connected to any adjacent rkiwewsi'pipe Yea No , f — <br /> DRAINAGE INLET REQUIRED Yes 0 No <br /> TomLength. ff- <br /> - <br /> (with proposed) Tool Nam of Sbm m Ds+k Inlets <br /> Nates <br /> 3. EEADWALL Yes fFRNI No <br /> 4. PAVED FRONTAGE: PAVED wifln ".Tcffm Depth A.C.over "hfin,Depth 3/4"A.B. <br /> Mesassithhg <br /> Fat in tach and Fed in width <br /> Drimmy FaaPermit base t Perbase fee..........:............. ..585. F16E$ <br /> Feld Inspalraa <br /> y of w/o pipe...--. _ <br /> ❑Paved 510000+0.46/8 <br /> ❑Drivewayw/boxCulvett„,..„._,.:... SiS5.00 <br /> _._ .. ❑Curb,Garter,Sidewalk....:.....__....,....5100.00+0.9878 <br /> CounterlComputer,cAAcc m\AM&atiou for <br /> PCImitIO.fMmy and Paved F <br /> matap Page.2 of 2 Revised=000 <br />