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1. That he/she has read alh the prdvisiow ofthis gTgratioa,and that the desadptioe mwkxied i8 this application am correct to the bast ofhis/har <br /> knawlvodge;and <br /> 'a <br /> 2. Tkat l;e/sho is the owner of tka regmctim properly,or is qualified to represad flee Owl and <br /> 3. That he/she will assume full reRxWS hr�ity fix'all Hability fiz pasonai injury Or damage to property wlnd:may arise out ofthe work desmibed above, <br /> or which may arise oat of his/her failure to do the workprovided harem;and <br /> 4. That in the evert any claim of sachlisbh'ht'y is made against The Coudy of San Joagiou or aay dopes,offal or employee thaeo&be shall <br /> defend,indemnify and holdiheuh and each of thea►bwm>%eas for such claim;and <br /> 5. That work shall be petted by the appliwmg and/or any rTresedatbia,of 1he apphicaut in the County Righti-of--Way at the above indicated site <br /> vd&a valid San Joaquin County Fiurancama t Pemfd;and <br /> 6. That if Pwnissi(n is S mated as requested,he agrees to do the wodc described in acoordance with all teams,conditions sad tnstricdicn of this and any <br /> attacked sheet,induded as generator special III provisions. / <br /> SigrralareofApplica si4ide nor <br /> FIELD INSPECTOR CONM90M <br /> L DRIVEWAY: Now ❑ Ditt ❑ Gravnl ❑ • Aggregate Baso ❑ Paved(taoa) ❑ Pavad(Good) ❑ <br /> 2. SLOPING: Ai yfhoan Pavemeut ❑ Towards Pavamant Flat ❑ <br /> 3: PIPES:. Now ❑ ExW S-Type /z% <br /> 01herpipesinn6*bedrood: Yes 21 No ❑ Approaches Crow Drain ❑ Sim <br /> Attachment to neighbor's pips Yes ❑ No <br /> 4 HEADWALL: Yes ❑ No <br /> s.ASPHALT CONCRETE DIIm , Yes ❑ No <br /> C.BARRIERS skngRig af•Way <br /> 4. Drrm Yes No ❑ If Yea:• V Style 2 Point ❑ Othhw ❑ VrW& Depth <br /> ?»»>»»»»»»»»»»»»a»»»>PERMITREQUiREMEM««««««««««««««««z«««< <br /> 1.JAMWAY. SFR COMMERCIAL ❑ At3RtCULTU" ❑ »DSTIUAL ❑ <br /> PAVED with 2 -"lute.Depth A.C,over. 9' "Mie Depiih 3/4"AR <br /> Nota <br /> 2. PIPE& Lan"of Pi"Ra"kvd: Ft and Diaor!eter of Pipe iooh <br /> To be connected to airy adjawaot driveway pipe Yes ❑.No <br /> DRAINAGE INLET REQUIRED Yea ❑ No <br /> Toto LaogdL (wilt proposed) Toldt Nm®Le r of 96wm:Drok hdeft <br /> Nota <br /> 3. HEADWALL Yes ® No <br /> 4. PAVED FRONTAGE: PAVED with "Mm.Depth AC,over "Mn.Depi h 3/4"A.B. <br /> Measuring Fetin lang@r and Feet in width <br /> FEES <br /> Driveway huroacbme t Permit barye fee........................$85.00 <br /> Field Ingwfion <br /> ❑Driveway w/or w/o pipe........_.:........ _._595.00 ❑Paved 5100.00+0.46/& <br /> ❑Driveway w/box Culvact._....._.._._........_...........___.5155.00 ❑Curti,Guaw,SidewaIL..:.._...............5100.00+0.98/ft <br /> C an daWbruputer,w:lAooesslApplioation for PannitsM iyeway orad Paved Frontage Page.2 aft Revis6d.W000. <br />