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ItLL+AJrrJAL:A.N'i 1f E KL.D I l.'EKl'JF -jES: <br /> 1. That he/she has read all the provisions of this aVpficafioa,and that the <br /> knowhwe m and iechrded kthis application are corned to the best ofhisflam <br /> 2. That he/she is The owner ofihe respec ive property,or is qualified to repro the oWne4 and <br /> 3..That he/she will assume full rity for att liability forpeasoml. <br /> niury <br /> or which may arise out of his/her failure to do the wockprogided haemo;andor&Gfte$0 Fmpedy which may arise out ofthe work deswibed above, <br /> 4. That is the event any claitn ofsuch yabgty is made againd theCematy of San <br /> defend,indemnify and hoklgm and each of them hm�mle,for��� ca any 'a�wtial car employee thereof he shall <br /> S. That work shall be peafarnmd by the applicant sard/or nay eve of the appticant in the County Right-ofat the above <br /> With a valid Sea Joaquin Courcy Eumachmeut permit;and indicated site <br /> 6. orf pemtissian is granted as ra rite!,he agrees to do the work described in ambm a wi&an tr+ums,eanditicros atnd <br /> Sheet included as&aural or redrictionoftuis and any <br /> St8�tm a of Applicaot.TM& <br /> Dago- <br /> FIELD 1NSPECTOR Copg6fg S <br /> :�'»»7»»»»»»»»»»»»»»»»»WMTMCONDITIONS««r«««««««««««<d«««««< <br /> L DRftWAY: Now ❑ Via }. Gmvd <br /> El AgMegaft Z SLOPING: frum Pa Q d <br /> Towars Pa Base, I] fva (poo) ❑ Paved(Good) ❑ <br /> 3: YIPES:. Nene 8- Flat <br /> Zype; <br /> Otherp4mmneighborhood: <br /> Yes ❑ No ..._ <br /> Attachment s Apl�'� 0 Croea Drain ❑ Size <br /> Yea ❑ No <br /> 4.HEADWALL: Yes .❑ No <br /> S.ASPHALT COKC1 XTZ DJMS- Yes ❑ Na <br /> 6..BAJtE KRS aloe$High O&Way <br /> 1. D1TCli Yes ❑ No Ifyea:• V <br /> Style ❑ 2 Pont ❑ Other ❑ widflt Depth <br /> »»»»»»»»»»»»»»»»»»per. , <br /> 1.DEMWAY: REQUIItEtdE1V1�«««««««««««««««««««« <br /> ,4 CO> >AL ❑ AO T� o � ❑ <br /> PAVED with .. If n,Depth A.C.aver " <br /> Mm Depth 3/4 AB <br /> Notes <br /> PD?K& Len8b of Pipe Rmq*od:• Pk and Diameter of pipe Inch <br /> To 6e oonoectedtoar ,adjscent4iy�yl Yes ❑ N� <br /> DR.AWAOE INLET REQUIRED Yes O No <br /> Tota]Lftgth.Noes (wdh Pt LE d TONu nkm etStmm DrDukItaEels <br /> 3. HEADWALL yes No / <br /> 4. PAVED FRONTACrE: PAVED with �✓" <br /> hrm Depth AG ova "Elm.Dept 3/4"AB <br /> Meeaumg Fed in teeter and <br /> _Feet in width <br /> Driveway Enavachment Permit base fee......:..: FEES <br /> ..... ..... ... .00 <br /> Pi Inspection <br /> Driv y w/or W/o pips......... <br /> ❑Drivewa $95.00ElPavedfiutw—_ _��__,—SIOO.00+O.g6/g <br /> ywn�osarly«t._._. <br /> ❑Curb,t3utter,SideWallr...:._. ...__. SI00.00+0.9818 <br /> c:�AoceaslApp)ioafionfnrP <br /> Way and Paved Frnatagie Page.22 <br /> Revised 8/2000. <br />