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1. That he/aria has lead art the provisions of this app on,and that the deser46on inchWed is this applications are correct to the best of his/her <br /> e kmwhvdge;and <br /> 2. That he/she is the owner ofthe respective property,or is gaaMed to r;pfaeut theowm,,and <br /> 3. That he/she will assamo fall respansihility fm all habit'y fez pasoasi ink,or damage to property vvhi h may arise out ofthe work described above, <br /> or which may arise out ofbb&er to lweto do the work provided herein.and <br /> 4. That m the event any claim of each liability is made against iheCowAy of San mina or any dMatmant,od$cW or employee theaeot;he shall <br /> defend,indenwify and holdthem and each of than harmless fur each claim;mid <br /> S. That weir shall be perfnemed by the applicant and/or any representative of the applicant in the Cowdy Right.-of--way at the above indicated site <br /> with a valid Sas Joacpk Coady Enmadmieot pav*and <br /> 6. That if penis ion is gmated as requested,he agrees to do the wads desmibed in acoor&cm with afl teams,oondWoos and restriction ofthis and <br /> attached iociuded as general II[ any <br /> X O Cv <br /> 3igneloraofApplTitie Daft <br /> FIELD INSPECTOR 1305 <br /> WaSTMO CONDMON3««r«««««««««««««««««< <br /> L DRftWAY: Now ❑ vat ❑ Gravel Aggregstel)aae Paved(poor) ❑ Pv(Good) ❑ <br /> Z SLOPINQ Amyfrom PYvemeat Towards Pavmnad ❑ Flat ❑ <br /> 3. PIPE&. Now E>isft-Type <br /> Othwpipesinneigbbachood: Yes p No Approaches Cross Dram ❑ Size <br /> Attachment to net s Pips Yes ❑ No <br /> a HEADWALL: Yee ❑ No <br /> S.ASPSALT CONCJ6 M DIICL►: Yes Na ❑ <br /> L.Bis -o&W y N/.4 <br /> i. DTPCS Yee ❑ No Ifyew- V Style ❑ 2 Mat ❑ Other ❑ Width <br /> Depth <br /> PERMITREQUIREM8M<z««««««««««««««««««« <br /> 1.DRM.WAY: SFR �. COMMERCCIA4. ❑ AORiCULTM ❑ INDUSTRIAL ❑ <br /> PAVED with Z "h fim Depth A.C.over ¢ "hfm.Depth 3/4"AB. <br /> Notes <br /> 2 PEMSc T mwb of Pipe Regakvd: Pt.and Din"cr of pips Each <br /> To be connected to anyadjaaeotdrivewaypipe Yes ❑.No <br /> DRAINAGE DUET REQUIRED Yee ❑ No <br /> Total I&%& proposes Tatall Number of Shorm Drok hdela <br /> Notes <br /> 3. HEADWALL Yes Q No . <br /> 4. PAVED FRONTAGE: PAVED with "hfm,Depth AG over "Mm Dep&3/4"A.R <br /> MewKing Fed in length and Feat tis width <br /> FEES <br /> Driveway EwroadmAnt Permit base fee........................... <br /> F Inepec8on <br /> away w/of w/o pipe......... .. _ S. ❑Paved fraataga �._ _....$100.40+0.46/& <br /> Driveway w/bos Cahroct._.._ _..... _. _ . .. _ .. .00 ❑Curb,Ower, ..:.. ...:...........5100.00+osm <br /> CounfaiComputer,c.\Acoese\Applioetion for PffmWlkiyeway and Paved Frontage Page.2.af 2 Revised 8/`1000 <br />