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•t tr n;tiCrLa�.tsi.�i n.ct�cu i �.Y.aaiirs�a: <br /> 1. That be/shehas read alt the provmma of Wia Mplcatim and that the description included is ibis application ami comet to the best of his/her <br /> kmwh-IM and ' <br /> 2. That he/she isttre ovmer•of the reqmctivepropedy,or is qualifiedto r arm t&e owner,and <br /> 3. That he/she will assarme fall cmpansfffity for all liability forpccsaoai iuycuy ordamage to property w i&mxy arise out of&o work described above, <br /> or which may arise out of hk&er failare to do the wo&provided hers;and <br /> 4. That in the event any claim of utich liability is made against*&Cordy of Sao kacpnn or my depuMmert,offidd or emptoym&%*4 be shall <br /> defend,indemnify and holdtbmr and each of thin hmadeas for mach chdm�and <br /> 5. That work shall be perfon nod by the applicao and/or any repme tahlro of the applicant in the Conmty Right-of-way at the above indicated site <br /> vd&a valid San 7oaquin County Fir wAmpat Permit;and <br /> 6. That if pemnission is gaited as requested,he agoras to do the wady desc nibed m tcoardmce with all teams,conditions and rnelric>tion of this and any. <br /> gEnllnah� 'O11m. /:12 G <br /> Srgnn4tte of TAte (~�`{// <br /> Daft <br /> FEUM INSPECTOR C011dMUM <br /> »»»»»»»»»»»»»»»»»»»»EMSTMOCONDTITONS«««««««««««««««««««« <br /> } <br /> L DRftWAY: Now Dat ❑ Q-V'A ❑ base ❑ Paved(Poor) ❑ Pswd(Good) ❑ <br /> 2. SLOPING: AsmyAmr Pavameot ❑ Towardm Psvamoraot ❑ Fiat <br /> 3. PJPES:. Now End-Type <br /> Otharpipes inneigbbodmd: Yes ❑ No Approwbee 0 Crass Drain ❑ Size <br /> AttachmanttoneigWmea Yes ❑ No <br /> 4.JK ADwAid� Yea El No' <br /> S.ASPSALT CONURM DW . Yes ❑ No / <br /> 6..BARRIERS atoag iZ*b a&Way <br /> 1. DMM Yes ❑ No IfYes:. V Style ❑ 2 Print ❑ Other ❑ With Depth <br /> «««««««««««««««««««<< <br /> 1.DRIVZWAY: SFR Al, COIdadERC ❑ AORfCMTUM ❑ INDUSTRIAL ❑ <br /> PAVED with �i "Mm.Deplh AC,over. "Min.DW&3/4"A& <br /> 13otes .. . <br /> 2. PUMM Lm%*of Pipe Regairpd:• Ft.and M=U*w of Pipe Inch <br /> To be mmootad to myadja "driveway pipe Yas ❑ No <br /> DRAINAM RMET REQUIRED Yea ❑ No IaGi, <br /> Totg1 Lang h: (vrilh proposed) Total Naber of SbummOnt s Tinted <br /> Notes <br /> 3. HFADWALL Yes Q No <br /> 4. PAVED FRONTAIE: PAVED with "ddim.Depth AC.over "Edm.Dep&3/4"A& <br /> Measuring Feet in tengi and Feet in width <br /> FEES <br /> Driveway Finmoacbme t Permit base fine ...... ...... .�85.Oo) <br /> Field In%)e tionKDav <br /> eway w/or w/o pipe.......... Paved f vafte.._...._.___.._....__.5100.00+4.46/& <br /> ❑Driveway w/box Cuhvat....._.._..__...—........._..„.......5135.00 ❑Crud,away,Sidewalk......._..:...._..-swom+0.981& <br /> CauntajCortpinta,c:lAccemslAppliaationfor PecmilslDr,"my and Paved Frontage Page.2 of 2 Revised 8/2000. <br />