Laserfiche WebLink
THE APPLICANT HEREBY CERTIFIES: <br /> I That he/she has read a!t the provisions of this application,and that the description included in this application are correct to the best o <br /> knowlwdge;and <br /> f his/her <br /> 2. T�he/she is the owner of the respective <br /> ProP�3S oris qualified to represent the owner,and <br /> 3. That heshe will assume full responsibility for all liability for Personal injury or damage to progeny which rata <br /> or which may arise out ofhis/her failure to do the work provided herein;and <br /> 4. That• Y arise out of the work described above, <br /> m the event any claim of such Hab' <br /> defend Inde �y made against the County of San Joaqiun or any department official or employee thereo <br /> ramify and hold them and each of the.harmless for such claim;and t he shall <br /> 5. That work shall be performed by the <br /> with a valid San Jo apphcaett���any rePr Tentative of the applicant in the Cotuity Right�f Way at the above indicated site <br /> Joaquin County Encroachment Permit and <br /> 6. That if permission is granted as nested he agTees to do the work described in accordance with all teams <br /> attache tta gen or Pecial III provisions. conditions and restriction ofthis and any <br /> inclu <br /> Signature of Applicant-Title y <br /> Date <br /> »»»»»»»»»»»»»»»»»»>FIELD INSPECTOR CONDWENTS <br /> EXISTING CONDITIONS«««««««««««<<<<<<««« <br /> I- DRIVEWAY: <br /> None ❑ Dirt Gravel ❑ <br /> 2. SLOPING: Aggregate Base ❑ Paved(poor) <br /> Away bora Pavement Towards Pavement ❑ Paved(Good) ❑ <br /> 3. PIPES: None Existmg-Type ❑ Flat ❑ <br /> Other Pipes in neighborhood: Yes ❑ No <br /> Attachment to nei bor's pipe: Approaches ❑ Cross Drain <br /> P P Yes 11 No he ❑ Size <br /> 4 HEADWALL: Yes 11 No g <br /> Q„ <br /> S. ASPHALT CONCRETE DIKE: s 'a .S,oc a <br /> Yes ❑ No <br /> 6. BARRIERS along Right-of Way <br /> 7. DITCH Yes ❑ No <br /> X If Yes: V Style ❑ 2 Point ❑ Other <br /> »»»»»»»»»»»»»»»»»»»» ❑ Width <br /> PERMIT Depth <br /> 1. DRIVEWAY: SFR ❑ MEN3S«««««««««««««««««««« <br /> COMMERCIAL <br /> AGRICULTURE ❑ <br /> PAVED with IIVDUSTRIAI, ❑ <br /> Notes -- Depth A.C.over Min.Depth 3/41,AB. <br /> 2. PIPES: Length of Pip,Required: <br /> ay a �—Ft.and Diameter of pipe h <br /> Inc <br /> Y Pipe Yes E] NoO <br /> To be connected to any adjacent driveway -- <br /> DRAINAGE INLET REQUIRED Yes <br /> ❑ No <br /> Total Length: [� <br /> Notes ----(with Proposed) Total Nmnber of Storm Dralm Inlets <br /> 3. HEADWALL Yes <br /> ❑ No <br /> 4. PAVED FRONTAGE: PAVED with <br /> Measuring <br /> ------ _ Min Depth AC.over <br /> ----,�_.11 Min.Depth 3/4"A.B. <br /> Feet in length and <br /> Feet in width <br /> Driveway Encroachment Permit base fee...................... FEES <br /> Field Inspection •.•.$85.0 <br /> ❑Driveway w/or w/o ❑ <br /> ❑Driveway pipe............................................ ...$95.00 <br /> w/box Culvert ....... <br /> ....................... .......... " Paved front ...................age.... 0 ...............$100.00+0.46/ft <br /> El <br /> Curb,Gutter,Sidewalk............. <br /> CounterlComputer,c:Access $100.00+0,9g/ft <br /> �APPEcation for PermitslDriveu ay and Paved Frontage <br /> Page 2 of 2 <br /> Revised 8/2000 <br />