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THE APPLICANT HERESY CERTIFIES: <br /> 1. That he/she has read all the provisions of this application,and that the description included in this application are correct to the hest 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 he/she will aswme full responsibility for all liability for persona;in ury or damage to property which may arise out of the work <br /> describixf 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,official or emp=.oyee <br /> thereof,he shall defend,indemnify and hold them and each of them harmless for such;claim:and <br /> 5, That work shall be performed by the applicant andilor any representative of the application in the County Right-of-`Nay at to above <br /> indli aced site with a valid Sate Joaquin County Encroachment Permit:and <br /> E. That if permission is granted as requested,he agrees to do the work described in accordance with all terms,condition and restriction <br /> of land any athcled sheet,incl rter or special til provisions. <br /> It a114 <br /> Signature o Applicant Title ate <br /> »»»»»>>?»»»»»»»»»»»»»»FIELD INSPECTION C01>MENTS«««««««««««««««««««««< <br /> EXISTING CONDITIONS <br /> 1. DRIVEWAY: None E] Dirt ir-7 GravelAggregate Base ❑ Paved(poor) l Paved;,good) <br /> 2. SLOPING: Away from Pavement Toward <br /> � . s Pavement F-1 Flat r7i ~l <br /> 3. PIPES: NoneExisting-Type <br /> Other&in neighborhood: Yes Lj No L_j Approaches Lj Cross Drain , Size. <br /> 4, HEADWALL Yes Q No(, <br /> 5, ASPHALT CONCRETE DIKE: Yes 7 Not <br /> 6. BARRIERS: along Right-of-Way <br /> T DITCH: Yes 17 NoXI if Yes: V Style Ell 2 Point u Other 7 W th Depth_ <br /> >>Y►»»»»>>?»»»»>>»»»»»»»»»»»>PERMITS REQUIREMENTS«c«««««««««««««««««««< <br /> 1. DRIVEWAY: SFR df Commercial [; Agriculture '1 industrial 171 <br /> Paved with 2- _"Min Depth A.C.over 14 "Min,Deoth:/1,`A.S.over <br /> Motes: <br /> 2. PIPES: Length of Pipe Required Ft.and Diameter of Pipe _ incl(es) <br /> To be connected to any adjacent driveway pipe. Yes 7, No <br /> Drainage inlet Required Yes E! No 77 <br /> Total Length: (with proposed) Total Number cf Storm Drain iniets: <br /> Notes: <br /> 3. HEADWALL Yes [j No <br /> 4, PAVED FRONTAGE: Paved with "Mir,Depth N.C.over "Min Depth 3/,,' A.B. <br /> Measuring Feet in length and Feet in width <br /> »»»»»»»»»»»»»»»»»»»»»»»»»»FEES««««<<<<<<«««««««««««««««««««« <br /> Driveway Encroachment Permit base fee �?clwoo J Z <br /> Reld . ri <br /> Z w(or w/o pipe $r 07-W- 'LJ Paved Frontage e 3.00+0.521-ft. <br /> Driveway W/bdx Culvert 1?S. G I Curb.Gutter,Sidewalk $�= 0. 0+1.05!ft. <br /> 3kr-EMTRALSERNICEMLEP;CALL-UMV.WKV.RASTER.?S3ER,'L'RO,C'tf.WP'T PERM.-,D a JEVV',e'rc 'acre 2.`2 <br />