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THE APPLICANT HEREBY CERTIFIES: <br /> 1 That he/she has read all the provisions of this <br /> his/her knowledge;andtt are rx�rrect toth <br /> e:best of <br /> 2. That he/she is the owner of the respective p%per#y,or ' '^ <br /> awl <br /> 3. That he/she will assume full responsibility for a#A#** ., <br /> described above,or which may arise out of hMot <br /> tt erase out of the work <br /> 4• That in the event any claim of such liability is made aqaWh <br /> thereof,he shall defend,indemnify and hold ftmw Samtor,empbm <br /> 5. That work shall be performed by the applicant and,W any NpVqq*#v0 of aph <br /> indicated site with a valid San Joaquin County E`04irr , ft V of# B*fit_0f.Way at the above <br /> 6. That if permission is granted as requested,he agrees to.do WoObeid 1n aCcwdance vftt*Ms,Wlditlon and restriction <br /> of this and any attached sheet,included asar�or sped <br /> Sire lot App icaMe <br /> nt Trtle <br /> »»»»»»»»»»»»»»»»»»»»»>R E#�) <br /> ««««««««< <<««««««««««< <br /> 1. DRIVEWAY: None ❑ Dirt ❑ Gravel R Aggro e ❑ paved <br /> (pm) PawedbDOO) ❑ , <br /> 2. SLOPING: Away from Pavement 0? Towards Pavement ❑ Flat ❑ <br /> 3. PIPES: None [] Existing—Type N,06 12- <br /> Other pipes in neighborhood: Yes <br /> 4. HEADWALL: Yes ❑ No <br /> 5. ASPHALT CONCRETE DIKE: Yes ❑ No <br /> 6. BARRIERS: along Right-of-Way <br /> 7. DITCH: Yes R"No ❑ If Yes: V Style [_i20'-'2 Point ❑ O#W ❑ Depth — e <br /> 544 <br /> »»»»»»»»»»»»»»»»»»»»»»»»IBRS <br /> ««mac««««<<««««««««««< <br /> 1. DRIVEWAY: SFR 2 Commercial ❑ Agriculture ❑ Irk <br /> Paved with "Min Depth A.C.over <br /> tea °A.B.o+�r <br /> Notes: <br /> 2. PIPES: Length of Pipe Required Ft and OWneter of Pipe <br /> inch(es) <br /> To be connected to any adjacent driveway pipe Yes ❑❑ No <br /> Drainage Inlet Required ❑ <br /> Total Length: <br /> (with proper TOWNUITAWd Sbo Drab,arm <br /> Motes: <br /> 3 HEADWALL: Yes ❑ No <br /> 4. PAVED FRONTAGE: Paved with "Min Depth A C over <br /> �' A Measuring Feet in len and M"t Depth 3A'A.B. <br /> Feet in wfdl <br /> »>>>>»»»»»»»»»»»»»»»»»»»»»»>pEES««««««««««««<<< <br /> Driveway Encroachment Permit base fee $90.00 <br /> E" d Inspection <br /> Driveway w/or w/o pipe <br /> Driveway w/box Culvert $i02.� Paved <br /> 00 $1{}$00}0 <br /> $167. Curb;,Vic; ,�iC�.CDp 103/ft. <br /> Y'%';M%S ( ,1E <br /> &TEMPIATESENNT PERMIT DRIVEWAY.d.(oM) + <br />