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11•.•,terra""vasa.a aauau.r�..�•�•��.�+..aa.v - <br /> 1. That he/she hes seed alt the provisos of this and that the description mchxW inthis WfimtcOn we 00med to the best of his/her <br /> knowhvdge'and <br /> .2. That he/she is the owAw Of the respective property,or hs VOMadto rVresed&o'ovmW-and <br /> 3. That he/she will assume full amity fav sit Liability fwPersonsd*Ory or dunagc to propeiiy whichmay sties rut afthe work desczizibed above, <br /> or which may arise out ofWs&cc faiturn to do the p wo& vvided havaio;and <br /> 4. That in the event anyclaim of suchliabdity u made apnwk ftCou ty cf San Jbaq Or SnY Official Of MVIOYW thereci;ba shall <br /> defend,indem»fy and holdttieuu and each of them humless for suds claim and <br /> 3. That work shall be performed by the Wficagt and/or any sepmecu dW of the applicant in the County Right-of-Vinay at the above indicated site <br /> with a valid San.Joagain County F.n roadmsent Pan*and <br /> 6. That if pennissim is Wanted he agrees to do the weak descn'bed in acomhnoe with an temps,omditi(m and mftic im offt and any <br /> attached inducted as &special Ili provisions. <br /> � <br /> SigoatnseOf ate Datat <br /> FIELD IKWECTOR CONMEU PS <br /> RMT[NOCONMOM««««««««««««««<«««««< <br /> L DRIVEWAY: None ❑ Dict Gravel ❑ AMegateBase Q Pa ) ❑ Pamd(Good) ❑ <br /> 2. SLOPING: Awayfinm Pa--A Y� ❑ Towanda PAva mat ❑ Flat <br /> 3.' PIPEW Now ❑ Exwft-Type f Q <br /> Other pipes inneighbodwod: Yes %--No ❑ Approaches Cross Drain ❑ Sias <br /> AttadmusttondgWxess�y*r. Yes ❑ No <br /> 4. HEADWALL- Yes ❑ No /d <br /> S. ASMALT CONCRETE DIKE: Yes ❑ Na <br /> G.BARRI1MS a"Righ4sf• .ay <br /> 9. Dn CH Yes No ❑ IfYes:• V Style Pb d ❑ Other ❑ Wdth Depth <br /> »»»»»»»»»»»»»»»»»»»PF.RMITRE 'TS«<c«««««««««««««««««« <br /> 1.DRM.WAY:. SFR COMMERCIAL ❑ AGRkM WM1 ❑ IN]DLNn?IAL ❑ <br /> PAVED with "Mia.Depth A.C.over "Man.Depth 3/4"AJ3L <br /> Notes <br /> 2. PIPE& Lem of Pipe Rewim&• Ft.and M"Imier of Pipe y, inoh <br /> To be comectod to ray adjacent mvemy pipe Yes ❑.No <br /> DRAINAGE INSET REQUIRED Yea ❑ No lJ <br /> Total Length: (wi h proposed) Total Nmebber of Sim=Dndau Itshfs <br /> Notes <br /> 3. tBADWALL Yes M No <br /> 4. PAVED FRONTAICE: PAVED with "h&L Depth A.C.over "Mm.Depth 3/4"AB <br /> Meamins Fedin Length and Feet in width <br /> Driveway Fncioacbmed Permit base flee......... ...... 383. <br /> id Inepeotion <br /> yw/of w/o pipe........ __ S. ❑Paved firooage _ _ _ _ _ 5100 00+0.4615 <br /> ❑Driveway w/box Cahrart. _.. . _ _ ❑cud,,Gutter,Sidewalk.. . S100.00+0.98M <br /> Couutmr Compirte,eMmess\Applioation for PmnilskDk ymmy rad Paved FinataRe Page.2.af 2 Ravlsed 8/2000. <br />