Laserfiche WebLink
THE APPLICANT HEREBY CERTIFIES: <br /> 1. 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 /> kaowlwdge;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 wont 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 Joaghm or any department,official or employee thereof,he shall <br /> defend,in6mmify and hold them and each of them harmless for such clams and <br /> 5. That work shall be performed by the applicant and/or any representative of the applicant in the County R gbt-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 accordancewith all terms,conditions and restriction of this and any <br /> attached sheet,included as general or special LII provisions. <br /> Signature of Applicant-Title Date <br /> FIELD INSPECTOR COMMENTS <br /> >>»»»»»»»»»»»»»»»»»»MaSTING CONDITIONS«««««««««««««««««««« <br /> 1. DRIVEWAY: None I <br /> ❑ Dirt � Gravel �, Aggregate Base ❑ Paved(poor) ❑ Paved(Good) ❑ <br /> 2. SLOPING: Away&om Pavement ❑ Towards Pavement ❑ Flat <br /> 3. PIPES: None ❑ Existing-Type <br /> Other pipes in neighborhood. -- Yes No R- Approaches ❑ Cross Drain ❑ Size <br /> Attachment to neighbor's pipe: Yes ❑ No ❑ <br /> 4. HEADWALL: Yes ❑ No ( ' <br /> 5. ASPS ALT CONCRETE DIKE: Yes ❑ No <br /> C BARRIERS along Right-of-Way <br /> 7. DITCH Yes ER-No ❑ If Yes: Y Style [''2 Point ❑ Other ❑ Width Depth <br /> »»»»»»»»»»»»»»»»»»»»PERMIT REQUIREMENTS«««««««««««««««««««« <br /> 1. DRIVEWAY: SFR R'r COMMERCIAL ❑ AGRICULTURE [PI'­ INDUSTRIAL ❑ <br /> PAVED with "Mia Depth A.C.over "Min.Depth 3/4"AB. <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 15 <br /> DRAINAGE INLET REQUIRED Yes ❑ No <br /> Total Length: (with proposed) Total Number of Storm Drain Inlets <br /> Notes -- —_-- <br /> t <br /> 3. HEADWALL Yes [] No <br /> 4. PAVED FRONTAGE: PAVED with — "Min.Depth A.C.over "Na.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 _i' Paved frontage..................................S 100.00 -0.46/ft <br /> DrivewaywiboxCulvert................................................SL55.00 F1 Curb,Gutter.Sidewalk......................S100.00� 0.98/ft <br /> CounterlComputer,c:"-AccesslApplication for PermitstDriveway and Paved Frontage Page 2 of 2 Revised 812000 <br />