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THE APPLIt ANT HEREBY CERTIFIES: <br /> IFIES: <br /> A. That he/she has read ail the provisions of t`iis application,and that the description included in this applicat are correct to the best of <br /> his/her 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 hefshe ,All assume foil responsibility for all liability for persona;imury or damage to property wh;,n 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 liability is made against the County,of San Joaquin or any department,ofiicia!or employee <br /> thereof,he shall defend,indemnify and hold them and each of there harmiess for s:;ch claim;and <br /> 5. That work s"all be performed by the applicant and/or any representative of the application,in the County:Right-cf-Way at the above <br /> indicated site with a valid San,foaquin.County Encroachment Permit;and <br /> 5. That if per 'ssion is granted as requested,he agrees to do the work described in accordance with ail terms.cond`ion and restriction. <br /> of this a ny attached sleet,in, as general ors;ectal{II provisions. <br /> c� ,► _ 9110110 <br /> Signature of Appli nt T i Late <br /> >»»»>»»»»»»»»»»»»»»»»>FIELD INSPECTION COMMENTS«««««««««««««««««««««< <br /> EXISTING CONDITIONS <br /> ?. DRIVEWAY: None !ii Dirt, 7! Gravel i Y Aggregate Base ❑ Paved(poor) Paved(good) <br /> 2. SLOPING: Away from Pavement r Towards Pavement J Flat 1-11 <br /> 3. PIPES: None L Existing—Type <br /> Other pipes in neighborhood: Yes _ No 'v' Approaches L; Cross Drain I J Size— _ <br /> 4. HEADWALL: Yes ❑ No <br /> ASPHALT CONCRETE DIKE: Yes 'i No <br /> o. BARRIERS: along might of-'VVay <br /> 7. DITCH: Yes i✓ No9,,i Yes: V Style ! 2 Point I Omer Width Dept? <br /> »»»»»»»»»»»»»»»»»»»»»»»»PERMITS REQUIREMENTS««««««««««««««««««««« <br /> 3. DRIVEWAY: SFR [2-` Commercial { Agriculture J Industrial 71 <br /> Paved with "Min Depth A.C.over "Min Dept %"A.B.over <br /> Notes: <br /> 2, PiPES: Length of Pipe Required �t.and Diameter of r, ipe inC ccs <br /> To be connected to any adjacent driveway pipe Yes J7 No - <br /> Drainage Inlet Required Yes F� No E—j- <br /> Total Length: (Arith proposed) Total Number of Storm Drain inlets: <br /> Nates: <br /> 3. 1'EAADVVAL1--: Yes El No �_a .-,-' <br /> 4. PAVED FRONTAGE: Paved with "Min Depth,A.C.over Min Depth <br /> Measuring Feet in length and =eet in,width <br /> »>»»»»»»»»»»»»»»»»»»»»»»»»»>FEES««««««««««««««««««««««««««« <br /> Driveway Encroachment Permit base fee 08.90- <br /> F& <br /> 90- <br /> F td inspection <br /> Driveway vd or wic pipe u laved Frontage ?3.0 t 0.521fn. <br /> Driveway wrbcx Culvert $175.00 L �-urb,Ginter, ci'devvalk ?, "0.00 ".05?fn. <br /> !r';:,_?iiu:!cE.^tiVICES'a'LE?{GALL'SUB-S'v.�d'4:t:,tlSrER,?SiEiiCF,O?Cri?fit.?'rE�M'i DRIV:ititiY.�C�. (,C..ci aage2c�2 <br />