Laserfiche WebLink
THE APPLICANT HEREBY CERTIFIES: <br /> I. That he/she has read all the provisions of this application,and that the description included in this application are correct to the best of his/her <br /> knowlwdge;and <br /> 2• That he/she is the owner of the respective property,or is qualified to represent the owner,and <br /> 3• That 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 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 Joaqiun or any department,official or employee thereof;he shall <br /> defend,indemnify 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 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 d,he agrees to do the work described in accordance with all terms,conditions and restriction ofthis and any <br /> attached sheet,' gen ecial III provisions. <br /> X Q <br /> Signature of Applicant-Title <br /> Date <br /> FIELD INSPECTOR COMMENTS <br /> >»»»»»»»»»»»>»»»»»»»»E)GSTING CONDITIONS«««««««««««««««««««« <br /> 1. DRIVEWAY: None Dirt ❑ Gravel [] Aggregate Base ❑ Paved(poor) ❑ Paved(Good) ❑ <br /> 2. SLOPING: Aw;-frrom Pavement [ Towards Pavement ❑ Flat ❑ <br /> 3. PIPES: None L 1 Existing-Type <br /> Other pipes in neighborhood: Yes ❑ No rDvr' Approaches ❑ Cross Drain ❑ Size C� <br /> Attachment to neighbor's pipe: Yes ❑ No L I <br /> 4. HEADWALL: Yes ❑ No [� <br /> 5. ASPHALT CONCRETED=: Yes ❑ No Q� <br /> 6. BARRIERS along Right-of-Way <br /> 7. DITCH Yes No ❑ If Yes: Depth <br /> V Style ❑ 2 Poi ❑ Other [Width <br /> »»>»»»»»»»»»»»»»»»»»>PERMIT REQUIREMENTS««««<<<<< < «««< ««< « <br /> 1. DRIVEWAY: SFR ❑ COMMERCIAL ❑— AGRICULTURE ❑ INDUSTRIAL ❑ <br /> PAVED with r"Min.Depth A.C.over "Min.Depth 3/4"A.B. <br /> Notes <br /> 2. PIPES: Length of Pipe Required: Ft.and Diameter of Pipe Inch <br /> To be connected to any adjacent driveway pipe Yes ❑ No [�]' <br /> DRAINAGE INLET REQUIRED Yes ❑ No El- <br /> Total Length: — (with proposed) Total Number of Storm Dram Inlets <br /> Notes 1 ____7 <br /> 3. HEADWALL Yes ❑ No [ � <br /> 4. PAVED FRONTAGE: PAVED with --"Min.Depth AC.over _ "Min.Depth 3/4"AB. <br /> Measuring Feet in length and —Feet in width <br /> FEES <br /> Driveway Encroachment Permit base fee............................$85.00 <br /> Field Inspection <br /> ❑ Driveway w/or w/o pipe.................................................$95.00 <br /> ❑ Paved frontage..................................$100.00+0.46/ft <br /> ❑ <br /> Driveway w/box Culvert................................................$155.00 ❑ Curb,Gutter,Sidewalk......................$100.00+0.98/ft <br /> CoumerlComputer,c:\Access\Apphcation for PermitslDriveway and Paved Frontage Page 2 of 2 Revised 8/2000 <br />