Laserfiche WebLink
THE APPLICANT HEREBY CERTIFIES: <br /> 1. That he/she las read all the provisions of this applir n,and that the description included mi this application are r ':x t to the best of his/her <br /> knowlvwdge;and ' <br /> 2. That he/she is the owner of the respective property,or is qualified to represent the owner;and <br /> 3. That helshe will assume full responsibility for all hWxky for personal injury or damage to property which may arise ant of the work described above, <br /> or which may arise out of his/her failure to do the work provided herein;and <br /> 4. That in the event any claim of such liability is made against the County of San Aoagkm or any depertmenk,official or employee thereon;he shall <br /> defend,indminity and hold them and each of them harmless for such claim;and <br /> 5. That work shall be performed by the applicant and/or any remove of the applicant in the County Rim-of-Way at the above indicated site <br /> with a valid San Joaquin County Ewsoachawmit Pen nit;and <br /> 6. That if 'on is granted as requested,he to do the work described in accordance with all teams,conditions and restriction of this and any <br /> m <br /> atas <br /> Sig eofApplicant-Title Date <br /> FIELD INSPECTOR COADMWTS <br /> «««««««««««««««««««« <br /> L DRIVEWAY: None ❑ DutZp< Gravel ❑ Aggregate Base ❑ Paved(poor) [] Pav*Good) ❑ <br /> 2. SLOPING: Away from Pavement ❑ Towards Pavement ❑ Flat <br /> 3. PIPES: Now Existing-Type <br /> Other pipes inn>ewkorhoo& Yes ❑ No ❑ Approaches ❑ Cross Drain ❑ Size <br /> Attachnient to neighbor's pipe: Yes ❑ No ❑ <br /> L HEADWALL: Yes ❑ No'API <br /> S. ASPHALT CONCRETE DIICE: Yes ❑ No <br /> 6. BARRIERS along Right-of-Way <br /> 7. DITCH Yes ❑ No 19 If Yes: V We ❑ 2 Point ❑ Other ❑ Width Depth <br /> »»>>>>> »»»»»»»»»»PERMTREQUIRMdENTS«««««««««««««««««««« <br /> 1.DRIVEWAY: SFR ❑ COMMERCIAL kq_ AGRICULTURE ❑ INDUSTRIAL ❑ <br /> PAVED with Z "Iin.Depth AC.over CA' "Mia Depth 3/4"A.B. <br /> Notes <br /> 2. PIPER: Length of Pipe Regdsed: Pt.and Diameter of Pipe Inch <br /> To be cotmadsd to any adjacent driveway pipe Yes ❑ No <br /> DRAINAGE INLET REQUIRED Yes ❑ No <br /> Total Length: (with proposed) Total Number of Stoma Draft Inlets <br /> Notes <br /> 3. HEADWALL Yes R No <br /> 4. PAVED FRONTAGE: PAVED with "h4in.Depth A.C.over "Mia Depth 3/4"AB. <br /> Measuring Few in length and Feet in width <br /> FEES <br /> Driveway Encroachment Permit base fee...........................$85 <br /> Feld Inspection <br /> DODriveway w/or w/o pipe........................................ ..$95.00 x ❑ Paved +0.46/ft <br /> ❑Driveway w/box Culvert._.............. .. ❑Curb,Gutter,SidewaHL......................$140.00+0.98/ft <br /> CounterlComputer,c:VxcesslApphcauon for Permits0riveway and Paved Frontage Page.2 of 2 Revised 8/2000 <br />