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.1r1JG tsa a yaysa i.a aauau.a.+..••�•��� �••••• <br /> 1. That ha/s has read all the provisions of this�and that the description inc aided is0his APPlication ale coned to the hest of his/her <br /> lmovdwdgq and <br /> 2. That tae/she is the owner of the respective prOpedy,or is qualified to represent the owner;and <br /> 3. That he/she will assume fall responsibBy€cx ail tiah,7'dy for personal injury or damage to property whkh may arise out ofthe work desmbed above, <br /> or whichmay arise out ofhis/her Mune to do She work provided herein;and <br /> 4. That inthe event any claim of sadilidAity is made agahwk t wCoawty of San kagi m or S11ydqwkmcxd,off cid or employee thereof;he shall <br /> defend,iodenmify and hold&=and each of them harmless.for such claim;and <br /> S. That work shall be performed by the applicant and/or any repave of the applicant in the Coupdy RigbWf--Way at the above indicated site <br /> with a valid San Joaquin County Facroadameot Pemtk and <br /> 6. That if permission is grained as reVested,he agrees to do the work described in aoomb we w'ithall terms,oondofiooa and neslridi(aofthis and any <br /> art wbod sheat,included as general or spacial III provisioner <br /> Sig-Ave ofApplicxmt-TMa Date <br /> FIELD 94MECTOR COMMUM <br /> »»»»»»»»»»»»»»»»»»»MUMII3QCONDMON8«««««««««««««««««««« <br /> L DRIVEWAY' None ❑ pat4} (ravel ❑ AwgpAeBase ❑ Paved(Poor) ❑ Paved(Good) ❑ <br /> 2. SLOPINQ Ainyfrom Pavau:ent Tomu ds Paoa maot •❑ Flat ❑ <br /> 3: PRES.-. Now ❑ Fig-ZHM <br /> Odwrpipee inadobashood: Ya"ALNINo Approaches E Cores Drain ❑ Size <br /> Attadme ttoadoboes Yes ❑ No /•ECSC <br /> L H$ADWALU Yes ❑ No' {�y S.ASP)#ALT CONCRETE DIIi3;: Yes ❑ No <br /> G.BARRIM alcog Right-ef•Way <br /> 1. Drreff Yes No ❑ Wye$:• V Style Print ❑ 0ther ❑ Wtdlh Depth <br /> »»»»»»»»»»»»»»> >>Pp�flTg (1; ENTs««««««««««««««««z«««< <br /> 1.DRIV .WAY: SFR COMMERCIAL ❑ AGRiCULTURE ❑ RMUSTRIAL ❑ <br /> PAVED with Z "Mm.Depth A.C,over "]1dm Depth 3/4"AR. <br /> Notes <br /> 2 PIPSd3: Lengih of PipeRegaiared Ft.and Dis 1Aw cf Pipe Inch <br /> To be oaanected to any adjacent driveway pipe Yee ❑.No �L- <br /> DRAwAt3E INLET REQUIRED Yes O No) Nr <br /> Total Leq* (wi h proposed) Total Nmahm of Sim=Dam hAda <br /> Notes <br /> 3. HEADWALL Yes No <br /> L PAVED FRONTAGE: PAVED with "Ma.Depth AC.over "Min.Depih 3/4"A.B. <br /> Measuring Feet ion tenth and Feet in width <br /> FEES <br /> Driveway Fnaoacbwa t Permit base flee......:...:.......... .....585 <br /> Inipecton <br /> MfJkW--y w/or w/o pipe........ Paved ftmtage _ __ _ $100.00+0.46/8 <br /> ❑Drivowayw/box Culvert._. __.__..__. _.$1$5.00 ❑Curb,(utter,Sidewa8r...:.......:....—,-$100.00+0981& <br /> Counte,\Compute,cAAccesslAppliaation for PermbMgyeway and Paved Frontage Page.2 42 Ravlaed 8/2000. <br />