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TI-IIr APPUCANTNERBY CERTIFIES: <br /> 1. That hekwbas read alt the provisions of this action,and that the description included in this application are correct to the best of <br /> ... <br /> Wb�m�and <br /> 2. T 1s,t11e owner of the respective property,or is qualified to represent the owner;and <br /> 3 That the>a assume full responsibility for all liability for persona;injury or damage to property which may arise out of the work <br /> above,dendbed or w6ich tray arise out of h�fier failure to do the work provided herein;and <br /> 4. T1 b the;e�a4y claim of such liability is trade against the County of San Joaquin or any department,official or employee <br /> r . _ ,irr emn yy and hold them and each of them harmless for such claim;and <br /> 5.1 T ark Upettorrned by the scant and/or any representative of the application in the County,Right-of Way at the above <br /> she s+ a n Joaqut� `'�ntr►ty Encroachment Permit;and <br /> 6. ThO pertnission is granted as requested,he agrees to do the work described in accordance with all terms,condition and restriction <br /> of thjs atlf;" at1whed def,included as general or special Ill provisions. <br /> ..I� <br /> o#App ate <br /> »y » » »»>>»»>y»»»»»»y»>>FIELp R6MTION CO ENTS«««««««««««««««««««««< <br /> DUSTING CONDITIONS <br /> 1. SAY: ❑ Dirt ❑ Gravel',❑ Aggregate Base ❑ Paved(lam) gi Paved(good) <br /> Z SI..OfM: y1 a�rn Pavement-[y Towards Pavement f-1Plat F-1 <br /> 3. PIPE: 1 ,❑ . EW"-Type. <br /> pipes in. Yes Lvff No U Approaches U Cross Drain U Size <br /> a <br /> 4. HEAD fA�: Yes No ❑ 0 1204eoR�v &:re <br /> 5. ASPHALT OONGRETE DE Yes ❑ No <br /> 6. WM; aloiV Rigl04Way a <br /> No ❑ If Yes: V Style ❑ 2 Point ❑ Other❑ Width Depth f <br /> 7. DITCH: Yes „�- <br /> y» > .�>4'044'i4f 001 »»»»»»»»»»PERMITS REQUIREME1 ««««««««««««««««««««< <br /> 1. DIRWISWAY., SFR Q"""' ornmereW ❑ Agriculture ❑ Industrial <br /> "Min Depth A.C.over "Min Depth 3/4"A.B.over <br /> Notes: <br /> 2. PIPES: Lir of Pipe Required Ft and Diameter of Pipe inch(es) <br /> To be oonneded to any adjacent driveway pipe Yes ❑ No ❑ <br /> Dr~kilst Required Yes ❑ No ❑ <br /> Total Length: (with proposed) Total Number of Storm Drain Inlets: <br /> Notal: <br /> 3. HEADWALL- Yes ❑ No <br /> 4. PAVWFRONTAGE: Paved with "Min Depth A.C.over "Min Depth%'A.B. <br /> Measuring Feet in length and Feet in width <br /> y»>»»>» »yy »»»»»»»»»»»»»»»»»>FEES«««««<<««««««««««««««««««««« <br /> D* ay Emmoft Perrnit base fee- $94.00 <br /> Feld <br /> 000* 1 W or,�o pie $102.00 Paved Frontage $108.00+0.50/ft. <br /> �1�r Cu I $167.00 Curb,Gutter,Sidewalk $105.00+1.03/ft. <br /> Y%VOFWC ':MWE1 VMftY.d.WA <br />