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'f tLAYYJA(;A.N'fIMKEHY ULKl•.E)@IES: <br /> 1. TLA he/she has•read all the provisions of this application,and*01 the description mounded iathis APPHC&fiM am correct to the best of his/her <br /> irnowtwdge;and <br /> 2. Thai he/she is the ownerof the respoc Live property,err is qct Med to neprasad the owns,and <br /> 3. That hdshe wa7f aieame fall raepoosility for all habTdy 6or Pomonai ajory or damage to property A"may ache out ofthe work descraw above, <br /> or which may arise out of Wslba More to do the workpcavided herein;and <br /> 4. That m the event nay daim of such litabilky is meds against SoCoatdy of San bagiun or any department,official or employee dwrool he ohall <br /> defaad,indemnify and hold them and each of them harmless fa such dais and <br /> S. Thad wait shall be performed by the applicant wN*r any representative of the applicant in the County Right of-Way at the above indicated site <br /> vft a valid Sac Joaquin County Fnamchmrt Bacot and <br /> b. That if pounission is granted as requested,lie agrees to do the work desom1W is soemdanoe vA&all tame,condkioos and reaeridion oMis and any <br /> sawbed shook included as general err special III promom <br /> S4pktmeofApplica4Tt& Darr <br /> FUM.D INSPECTOR COMMENTS <br /> >>>>> »»»»»»»»»»»»»»EMS'lING CONDMONS««r«««««««««««««««««< <br /> t <br /> L DRIVEWAY: None ❑ Dart Gravel ❑ Aggregate Base p Paved(Poor) ❑ Paved(Good) p <br /> Z SLOPING: AwaySam Pavamaor Towards Pacaemeot p Flat p <br /> 3. PEM& Now E1 -Type <br /> Other pipes innd*badwod: Ya ❑ No Approa&w 0 Crow Drain ❑ Sine <br /> Art d meut to naglmoes pips: Ya ❑ No JZ <br /> A HEADWALL, Ya ❑ No' JK <br /> S.ASPSALT CONCRETE CRETE DUM- Ya ❑ Na fig <br /> &.RARRUMS &kvW Rim way AJ A <br /> 7. DITCH Yes ,0 No ❑ Iffeez. V Styb 2 Point ❑ Other ❑ VrW& Dep6t <br /> ««««« <br /> 1.DEWMAY: SFR COMMERCIAL ❑ AGR>CULTUR$ ❑ IIIDU3 MAL ❑ <br /> PAVED with 2 "Min,Deplb AC,over 4. Irn.Dep&3/4"A.S. <br /> Nates <br /> 2 PIPS& Length otPipe Regsitod: Pt.and Dia,"er of Pipe Inch <br /> To be connected to nay adjaoent driveway pipe Yes ❑.No <br /> DRAINAGE INLET REQUIRED Ya ❑ No <br /> TOW T ft gtb (wilbProposed) Total N®Ler of Sim=Dvaft Ialela <br /> Nota <br /> 3. EUKADWAL L Ya Q No . <br /> d PAVED FRONTAC;E: PAVED with "Min Depth AC,over "Min.Dep&3/4"AB. <br /> Maswiog Fed in laog(hand Feat in width <br /> FFA9 <br /> Driveway Luxvischmeat Permit bene fee _.... __ ..... _.485.00 <br /> Field Inspection <br /> ❑Driveway w/a w/o pipe..._._ _ ,_ ❑Paved 4100.00+0.46/8 <br /> ❑Driveway w/boa(�lveri._ __ _. ___. „ 155.00 ❑Corby(uaw,SMawaik-.-..... -._-,-$100.00+0.98/R <br /> Ccutaa�CAMPAer,c:\AcoeuWplioation for PermdsOf!eway and Paved Frontage Psge.2 oft Revised 8/2000 <br />