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lam. Ali -r:rip _1. tJJ .:.G 7G C�1J L�-'Vl IY,_JI: _, <br /> t r-n_.IL V <br /> 11-21-'08 09:20 FROM-DILLON & MURPHY 1-209-334-0723 T-442 P03/03 L'-413 <br /> THE APPLICAN-T HEREBY CE8TIFiES: <br /> '. 71 of he/she has read a!1 fie provisions of this application,and tha!the description fcluded in this applicaticn are correct to the best of <br /> his/r er knowledge;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 haNlity for persona;injury or damage to property which may arise out of the work <br /> described above,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 llabil)ty is made against the County of San Joaquin or any department,official or employee <br /> thereof,he shall defend,Indemnify and hold them and each of them harmless for such claim;and <br /> S. That work shag be performed by the applicant and/or any representative of the application In the County Right-of Way at the above <br /> indicated site with a valid San Joaquin County Encroachment Permit;and <br /> 6. That if permission is granted as reauested.he agrees to do the worts described in accordance with all terms,condition and restriction <br /> of thi� a y a ed t, kided as general or special III provislons, <br /> /Signature of Applicant Title DEIS <br /> »»»>>>>> »»»>»»»»»»»sFlELD INSPECTION COMMENTS«««««««««««««««««««««< <br /> EXIS'T'ING CONDITIONS <br /> .1, DRIVEWAY: None ❑ Dirt, Gravel ❑ Aggregate One ❑ Paved(poor), Paved(good) ❑ <br /> 2. SLOPING: Away from Pavement * Towards Pavement t Flat ❑ <br /> .3. 'PIPES: None Existing-Type <br /> Other pipes in neighborhood: Yes U o LJ Approaches LJ Gross Wn tj Sue <br /> 4. HEADWALL: Yes ❑ No <br /> 5. ASPHALT CONCRETE DIKE: Yes ❑ No <br /> 8. <br /> -BARRIERS: along Right-of-Way, <br /> 7. DITCH: Yes ❑ No 94 Yes: V Style ❑ 2 Point ❑ Other ❑ WkM Depth <br /> »»»>»>»»>»»>»»»»»»»»>»»>»»»PERMITS REQUIREMENTS««««««««««««««««««««« <br /> A. DRIVEWAY: SFR ❑ Commercial Agriculture ❑ Industrial ❑ <br /> Paved with Un Depth A.C.over 'Min Depth A.B.over <br /> Motes: <br /> 2. PIPES: Length of Pipe Required __- 7/' Ft.and Diameter of Pipe _ _ inch(as) <br /> To be connected to any adjacent driveway pipe Yes ❑ No <br /> Drainage Inlet Required Yes ❑ No <br /> Total Length: (watt proposed) Total Number of Storm Drain filets: <br /> Notes: <br /> .3. HEADWALL: Yes ❑ No,ff" <br /> 4. PAVED FRONTAGE: Paved with 'Min Depth A.C.oer 'Min Depth%'A.13. <br /> Measuring Feet in lengt nd Feet in width <br /> »»»»»»>>»»»»»»»»»»»» <br /> Driveway Encroachment Pem,, base fee_______$90.00 <br /> F Id I <br /> J <br /> Driveway w(or w/o Rifle $f{)2.GJ x�J Paved Frontage t <br /> Drivewa w/bex Culvert g $ 08.00 . 0.50M. <br /> Y T167.Do 5 Curb.Guttef,Sidewaik $105.00+f_03ft. <br />