Laserfiche WebLink
THE APPLICANT BEREBY CERTIT"IES: <br /> 1 That he(she has read all the provisions ofthis application,and that the description included in this application are correct to the best of his/her <br /> knowlwdge;and <br /> 2 Ihet he/she is the owner of the respective property,or is qualified to represent the owner;and <br /> 3 I hat he/she will assume full responsibility for all liability for personal injury or damage to property which may arise out of the work described above, <br /> or which may arise out of hisiher failure to do the work provided herein;and <br /> 4 Ibat in the event any claim of such liability is made against the County of San loagiun or any department,official or employee thereof;he shall <br /> defend,indemnify and hold them and each of them harmless for such claire;and <br /> 5 That work shall be performed by the applicant and/or any representative of the applicant in the County Right-of-Way at the above indicated site <br /> with a valid San Joaquin County Encroachment Permit;and <br /> 6 That if permission is granted as requested,he agrees to do the work described in accordance with all terms,conditions and restriction of this and any <br /> attached sheet,inclu as I ectal sions <br /> Signature Applieant-4itle Date <br /> FIELD INSPI:C'I'OR COMMENIS <br /> »»»»=»»»>»:»»»»»»»»»»»EMS'IING CONDITIONS«««««««««««««««««««« <br /> 1. DRIVEWAY: None ❑ Dirt ❑ Gravel ❑ Aggregate Base ❑ Paved(p—r) ❑ Paved(Good) ❑ <br /> 2. SL OPING: .Away from Pavement ❑ Inwards Pavement ❑ Flat 0 <br /> 3.. PIPES: None ❑ Existing-Type _ <br /> Other pipes in neighborhood: Yes ❑ No ❑ Approaches ❑ Cross Drain ❑ Size <br /> Attachment to neighbor's pipe: Yes ❑ No ❑ <br /> 4. HEADWALL: Yes ❑ No ❑ <br /> 5. ASPHALr CONCREIE DML: Yes ❑ No ❑ <br /> & BARRIERS along Right-of•Way <br /> 1. DIICH Yes ❑ No ❑ If Yes: V Style ❑r2 Point ❑ Other ❑ ^Width Depth— _— <br /> »»>.>>»»»»»»»»»»»»»»»»>PERMII REQUIREMENIS <br /> I. DRIVEWAY: SFR ❑ COMMERCIAL ❑ AORICULIURE ❑ INDUSIUAL ❑ <br /> PAVED with Min Depth AC,over --"Min Depth 3/4"A& <br /> Notes YW -- <br /> i <br /> 2. PIPES: Length A Pipe Required: Ft and Diameter of Pipe Inch <br /> To be connected to any adjacent driveway pipe Yes ❑ No ❑ — <br /> DRAINAGE INLE I REQUIRED Yes ❑ No ❑ <br /> Iota]Length: _ (with proposed) I otal Number of Storm Drain Inlets <br /> Notes - <br /> 3. HEADWALL Yes 0 No Q <br /> 4, PAVED FRONIAGE: PAVED with "Min Depth AC over ---"Min.Depth 3/4"AB. <br /> Measuring Ieet in length and Feet in width <br /> FEES <br /> Driveway Encroachment Permit base fey. 85.00 <br /> Field Inspection <br /> Driveway w/or w/o pipe $95 00 X Z ❑Paved frontage, <br /> ,\ <br /> ❑Driveway w/box Crlvert $15500 ❑Curb,Gutter,Sidewalk <br /> CounterlComputer,c:lAccesslApplication for PemnitslDriveway and Paved Frontage— Page 2 of 2 / Revised 8/2000 <br /> 40 r IG <br /> 0,9 8/4 ��6 <br />