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THE AM"Off , y FO <br /> 1 ;prov cions of this application,and that the description included in this application are correct to the best of <br /> is Owm d tte respective property,or is qualified to represent the owner;and <br /> 2. Tto bows <br /> pwsibility for all liability for persona;injury or damage to property which may arise out of the work <br /> MY arse out of his/her failure to do the work provided herein;and <br /> 4. <br /> of such liability is made against the County of San Joaquin or any department,official or employee <br /> mdeqvf#y troll them and each of them harmless for such claim;and <br /> 5 T W0*1".1* .I by the applicant and/or any representative of the application in the County Right-of-Way at the above <br /> . ' JoagM,County Encroachment Permit;and <br /> 6 -Ttol I is.gianda'd as requested,he agrees to do the work described in accordance with all terms,condition and restriction <br /> 2trly Wit,included as general or special III provisions. <br /> icant Title ate <br /> » > y y>>y>y»> »»>y »y>»»>>>FIELD INSPECTION COMMENTS«««««««««««««««««««««< <br /> EXISTING CONDITIONS <br /> a:%%YDirt Q Gravel ❑ Aggregate Base ❑ Paved(poor) El Paved(good)of ❑ <br /> 1 SLlGt: paqqy.jrompavawAQ Towards Pavement ❑ Flat [} <br /> 3. PM: 01 <br /> " Type <br /> 'rt�od: Yes No Approaches Cross Drain Size <br /> 4. WEADWALL Yes'.❑ NO <br /> Yes ❑ No <br /> �tEE3S lel ' - Fail <br /> 7. DIT : Yes, No ❑ g Yes: U Style <br /> 2 Point ❑ Other ❑ Width _�_�__ Depth C <br /> > , >.,,,,>>>>>>>��y}»»»»»»»»>PERII TS REQUIREMENTS««««««««««««««««««««« <br /> 1. DSI#VE-WAy- ❑ CoworcW ❑ Agriculture ❑ Industria(Paved W* ❑ <br /> "Min Depth A.C.over "Min Depth 3/<"A.B.over <br /> Notr <br /> 2. PIPES: Leno of Pipe Required <br /> Ft.and Diameter of Pipe inch(es) <br /> To wed to any adjacent driveway pipe Yes ❑ No ❑ <br /> Drak"e,k*,t Required Yes ❑ No ❑ <br /> Tc # (with proposed) Total Number of Storm Drain Inlets: <br /> F +s' <br /> 3 I ADWALL: Yes ❑ No ❑ <br /> "Min Depth A.C.over "Min Depth3/4"A.B. <br /> `I' PAS I`l Feet in length and Feet in width <br /> > »>y>y»»»>»»'»>y»»»»»»»>FEES««««««««««««««««««««««««««« <br /> €X B $90.00 <br /> w!ctt rr pt} $102.00 Paved Frontage $108.00+0.50/ft. <br /> l}�e�vac $167.00 ❑ Curb,Gutter,Sidewalk $105.00+1.03/ft. <br /> Y1PC,1pY1S6TA. . PEI�EOgYE'�YAoe�ey <br />