Laserfiche WebLink
1. That helshe has read all the provisions of this application,and that the description included in this application are correct to the best of <br /> hisernowtedge;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 U responsibility for all liability 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 dafin of such liability is made against the County of San Joaquin or any department,official or employee <br /> thereof,he shag defend,indemnify and hold them and each of them harmless for such claim;and <br /> 5. That work snarl be-.pwforrned by the applicant and/or any representative of the application in the County Right-of-Way at the above <br /> indicated site with a vald San Joaquin County Encroachment Permit;and <br /> 6. That if permission is granted as requested,he agrees to do the work described in accordance with all terms,condition and restriction <br /> of this and any attached sheet,included as general or special III provisions. <br /> Signature o Iicant Title Date <br /> »»»»»»»»»»»»»»»»»»»»»>FIELD INSPECTION COMMENTS«««««««««««««««««««««< <br /> EXISTING CONDITIONS <br /> 1. DRIVEWAY: None Dirt ❑ Gravel ❑ Aggregate Base ❑ Paved(poor) ❑ Paved(good) ❑ <br /> 2. SLOPING: Away from Pavement ❑ Towards Pavement a'-Flat ❑ <br /> 3. PIPES: None Existing-Type <br /> Other pipes in ihbcxhood: Yes No Approaches Cross Drain Size <br /> 4. HEADWALL Yes ❑ No <br /> 5. ASPHALT CONCRETE DIKE: Yes ❑ No <br /> 6. BARRIERS: along Right-of-Way + <br /> 7. DITCH: Yes ❑ No Yes: V Style ❑ 2 Point ❑ Other ❑ Width Depth <br /> »»»»»»»»»»»»»»»»»»»»»»»»PERMITS REQUIREMENTS««««««««««««««««««««« <br /> 1. DRIVEWAY: SFR Commercial ❑ Agriculture ❑ Industrial ❑ <br /> Paved with r "Min Depth A.C.over "Min Depth%'A.B.over <br /> Notes: <br /> 2. PIPES: Length of Pipe Required `` Ft.and Diameter of Pipe inch(es) <br /> To be connected to any adjacent driveway pipe Yes ❑ No <br /> Drainage Inlet Required Yes ❑ No ( °' <br /> Total Length: (with proposed) Total Number of Storm Drain Inlets: <br /> Notes: <br /> 3. HEADWALL: Yes ❑ No �4 <br /> 4. PAVED FRONTAGE: Paved with "Mira Depth A.C.over "Min Depth'/d"A.B. <br /> Measuring Feet in length and Feet in width <br /> »»»»»»»»»»»»»»»»»»»»»»»»FEES««««««««««««««««««««««««««« <br /> Driveway Encroachment Permit base fee $125.00 <br /> Field In <br /> Driveway w/or w/o pipe $110.00 ❑ Paved Frontage $116.00+0.53/ft. <br /> Driveway w/box Culvert $179.00 Curb,Gutter,Sidewalk $113.00+1.08/ft. <br /> 11SJPWGOV.ORGISWESICENTRALSERVICESICLERICALIPUB-SV.WKW1ASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 2 of 2 <br />