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121U to a au..rra.. a iaaau.+•a. .. a.......,a• <br /> 1. That he/afle Lea read all the provisions of this applicatim and that the description i w oiled iathis application are coarse#to the best of his/her <br /> knowlwdm and <br /> 2. That he/she is the owner of&a respective prope dy,or is gulified to represent the ownee;and <br /> 3..That hedshe wi7i assume fall oily far 29 Fiabd'dy forpexsonai*my or damage to propecty which may arise out ofthe wodc dmar bed above, <br /> or which may stun out of his&w failare to do the workperwided hexaiu;and <br /> 4. That m the event any claim of such liability is made against*eCoanty ofSan or am'y depaatnaeg,official or employee thereof,her shall <br /> defend,indemnify and hold*mn and each of&=ham im for sack elasm;and <br /> 3. That work shall be performed by&a applicant and/or any represeetafive ofthe appficant in the Canty Right-of-Way at the above indicated site <br /> vd&a valid San Joaquin Comely Encroachma t Pan*and <br /> 6. That if pwmission is granted as regiusted,he areas to do the wade dews'bed m accordance wi&all teaus,eon and restcictionafthis and any <br /> attaeed � 7 -d <br /> ,,,77= <br /> '{ Qi�,.,��,�.,� 9 <br /> Si8+A V Cf T0ar .Dates <br /> FIEM INSPECTOR COQ <br /> <<< < <br /> L DRItrEWAY: Now Pnt ❑ Q vel ❑ Aggregate save ❑ Pavagpoor) ❑ Paved(Good) ❑ <br /> 2. SLOPING: Aw&yfwmPavemat p Toe ar&Pavmneot ❑ Flat . <br /> 3. PIPE&. Nage Ea: ft-Type <br /> 01herpipesianeig hood: Yes ❑ No Approaches F Cross Drain ❑ Sire <br /> Attachment to neigVmis}p�ipe: Yea ❑ No <br /> 4 HEADWALL: Yes ❑ .No' <br /> S.ASPRALT CONCJ6 M Yea ❑ Na <br /> 6G.BARRIERS akegKWt-c&Way <br /> 7. DITM Yes ❑ No IfYes:' v style ❑ 2 Foist ❑ other ❑ vrm Depth <br /> »»»»»»»»»»»»»»»»»»PBRLUTREQUIREMENTS<z««««««««««««««««««<< <br /> 1.DR n*AY:. SFR nCOMRMMCL4L p A+C#RfCULTV" p RgDUSTWAI, ❑ <br /> PAVM vft G "Mia.Depth A.C,over "Mm.Depth 3/4"AR <br /> 2. PUSS L *s am..Regained: Ft.and Diem w of Pipe —�-- Inch <br /> To be connected to any a*omt*iveway pipe Yea .No Ip1L,, <br /> Dit"AOE RffZf REQUIRED Yea ❑ No <br /> Tow Lmg& Toted Number of%K=:Drehe laid <br /> Niles <br /> 3. HEADWALL Yes Q No <br /> 4. PAVED FRONTAgE: PAVED with "Mm.Depth AC.over "Milos.,Depth 31V A.B. <br /> Measueing Feet in Length and Feet in wiefth <br /> F):EES <br /> Driveway Fnctoachmmt Pennit base five.........:. . ..... .S85. <br /> WIDUrmwa <br /> yw/orw/o pipe........_..................:..........._..... S95_ ❑Pavadfroaotaga.w._____._....._....SI00.00+0.46/& <br /> ❑Driveway w/box Calvet. _ _...... _ .. .. 00 ❑Cueb,Gutter,Sidav&..:.......:....__...SI00.00+0.98/& <br /> CcuntalCompirter,cAAco—\Appfioation for PamWDgyeway and Paved Frov*p Page.2 of 2 Revised 8/2000. <br />