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ti,P <br /> _ . PviCAIN T H`R E3Y CART;FiES: <br /> h hat h isne as r anthe pro+visions of this application,and that the d iptioo induded in this application are coriW to t best of <br /> 2. That he/she Is the owner of the respective property,oris qualified to represent the>owrorr and <br /> 3. That he/she wil!assume full responsibility for all liability for persona;injury or Janna th <br /> described above,or which may arise out of his/her failure to do the work � a <br /> 4. 7ha, :1 he event any ciaim of such armless for such�;an <br /> iability is made against the County of San�Ioaquin or arty depstment <br /> thereof.he steal;defend,indemnify 3„d hold them and each of them h a <br /> d ft or <br /> 5. That work shall be performed by the applicant and/or any representative of the apphoation in the <br /> indicated site with a valid San Joaquin County Encroachment Permit;and CoU* at the a <br /> ftm-OILWAY <br /> 6. That if Permission is granted as requested.he agrees to do the work described in 9ccordartm wft all terms, <br /> c*this and any attached sheet.included as general, r In and re <br /> n g ra o special Ill provisions. <br /> �,,'' Signature o.. ,p icani Title <br /> »»>»»»»»»»»»»»»»»»»»»»MELD INSPECTION Ci?MlI EES«««<««<<.««<<«««<,<e c«<t< < <br /> EXISTING CONDIT ONS <br /> `. DRIVEWAY.- done 71f Dirt 7 Gravei Aggregate Base Q Paved(poor) Q Pali(good) (� <br /> 2. SLOPING: Away from Pavement ”'Towards Pavement 17 Flat 17 <br /> u. P9a;S. Nonexisting-Type Z r x � " :�° �Jrz. e, � <br /> n. <br /> Other pipes, neighborhood. Ye ,�s NO� � <br /> Approaches Cross L3 Sim <br /> 4, HEAD1,1 ALL: Yes : No <br /> nRET <br /> J. ASPHALT VCI���r•?c D;KE. Yes 17 No <br /> 6. BARRIERS: along Rig!t-cf-','lay <br /> . ?ITCH: Yes 1..No L; If Yes: `v Style "1 2 Point 17_ Other Width <br /> Depth <br /> »»»»»»»»»»>»»»»»»»»»»»»»>PERITS REQUIREMENTS««««««s«««««««««<.�c«« <br /> '. DRIL`E4AY: SFR f Commerc€al :: Agriculture F7 Industrial <br /> Paved with <br /> "lain Depth A.C.over <br /> -� "Min Depth AR over <br /> Notes.- <br /> 2. <br /> ot <br /> .es: , <br /> 2. PIPES: Ludt^of Pipe Required <br /> Ff.and Diameter of Pipe " inch(es) <br /> c <br /> be conmec ed to any adjacent driveway pipe Yes �°`•No r__1 �_' � ,��� 0,4« <br /> Drainage inlet RequiredYe <br /> Tos l-1 Nota. _ <br /> Length: <br /> ,with proposed; Total Number of Storm Brain Inlets: <br /> `dotes: <br /> v.. HIEADIAVALL. Yes J No _, ,• <br /> 4. PAVED FRONTAGE: <br /> agedviti "Mlin Depth A.G.over_ "Min Depth <br /> l<'A B. <br /> N'leaswring Feet in;length and feet in width <br /> »»»»»»»»»»»»»»»»»»»»»»»»»»»FEES«««««««««<<<«c<'C««<<<""5<<'<<<<<<<"C<< r <br /> Driveway Encroachment Permit base fee 5^UrJ.00 <br /> t;eld Inspection <br /> Drivewa} rv/or Nr10 i'1L WFLr <br /> Driveway w/box Cuive;4 S b uG `I raved Frontage $113.00+0.52/ft <br /> �4'rcts r L Curb,Gutter,�I�" `_'_$190.00+1.05fft. <br />