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1. That hd le has read all the provisions of tbas�and that the deacriptioa ioctoded mthis application ate correct to the bast of his/her '" <br /> knowlwdge;and <br /> 2. That be/dw is to owner of the ragmctive pmpetty,or is gwMod to represent the ovmeq and <br /> 3. That hdsho will assume fall reepWobildy for all fi*W4 farpersonsi iajary+or damage to property which may arise out of&o work desmffied above, <br /> or whichmay arise out ofhis,&er failure to do the worlcpanvk1edherehr and <br /> 4. That in the evert any claim of such liabi ify is made against lbeCaunty of San kagimn or any&Pn*R9Uk official or employee thereof he shall <br /> dofmd,indemnify and holdlim and each of theta harmless for such clams;and <br /> S. That work shall be performed by the applies*and/or any repr+eseds&c of the appficaut in the Cowo*y Right-of-Way at the above indicated site <br /> with a valid San Joaquin Comity Fmt Permit;aid <br /> 6. That if pemhission is gtataed as tae agrees to do the wmk described in accordance wi8haif terns,000diiiaw and restriction ofibis and any, <br /> sttachodas spoda ni ons <br /> of.4pglia -Fifle Daft <br /> FIELD I NSPECPOR CO1 RMOUIT8 <br /> »»»»»»»»»»»»»»»»>}»»ENISTR4000NDrIlON S«««««««««««««««««««« <br /> L DRIVEWAY: Now ❑ Dat Gmvol ❑ Aggrega*eBase ❑ Paved(pow) ❑ PavCDOod) ❑ <br /> 2. SLOPING A frau Pavema t ❑ Towards P.W..A Flat ❑ <br /> 3. P1PZS.. Now E$kft-Type <br /> Otherpipes inneighbcatiood Yes ❑ No Appcoedtea 0 Cm Drain ❑ Sim <br /> Attwbmu t to ne~a pipe: Yoe ❑ No <br /> 4.HEADWALL: Yes ❑ No j <br /> S. SrU r T CONCRETII Yes ❑ No At <br /> 6..BARR MS afoag RWA-a&Way <br /> 1. DWCH Yes ❑ No IfYec. V`91* p 2 Pout ❑ Other ❑ W-W& Depth <br /> >»»»»»»»»»»»»»»>>> PERMITREQUMEMENTS««««««««««««««««e«««< <br /> 1.DI M.WAY: SFR k COMMERCIAL ❑ AGRiCULTURE ❑ INDUffrRIAL ❑ <br /> PAVED with "Mea.Depth AG over "Mm.Depth 3/4"A13. <br /> Nates <br /> 2. PIPE& Lawn of Pipe Rwpko& FL and DiuA.A r of Pipe inch <br /> To bec000ecWtoanyadjaccaddtivewaypipe Yes ❑ No <br /> DRAINAGE INSET REQUIRED Yes ❑ No <br /> ToW Length: (with"osed) Total Nu ober of Sem:Drafit Weis <br /> Nates <br /> I HEADWALL Yes Q No re <br /> 4. PAVED FRONTAgE: PAVED with 16L 1)apth A.C.aver "]i6m 1k+p8t 3/4"A.B. <br /> Measuring Feet in leng&aad Feet in width <br /> FEES <br /> Driveway hwroachmuY Permit base tae..........:..... <br /> _...... ..583. <br /> F inspection <br /> awayw/orW/o pipe.:........ <br /> � _ ❑Pavai&Aga..........._.._......__—$100.00+0.461& <br /> ❑Driveway s/box Cahat._.. _ _»... _.... SiSS.00 ❑Crab,outer.Sidewalk.........—...--...5100.10+0.98/ft <br /> Ceuntei\C0Rxt r,c:lAccesSVWPliaation for PermdO veway and Paved Frontage Page.2 of 2 Revisad 8/2000. <br /> 's <br />