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1 Ti t helshe Inas read all fly provisions of this application,and that the description included in this application are correct to the liv^sr,f,_ <br /> h'WW Ic I%,and <br /> 2 cif rapee Ierty+,or is qualified to represent the owner;and <br /> g - 1 a fW�l by for a#liability for persona;injury or damage to property which may arise out of the work <br /> ;, tt atrse cit t f►isrfallure to do the work provided herein;and <br /> 4. That in the end array deka of mchfiabft is merle against the County of San Joaquin or any department,official or employee <br /> ftvd, ,# tntii r:ar I ho6d`them and each of them harmless for such claim;and <br /> 5. That pqo�q�t ,,the applicot andfor any representative of the application in the County Right-of-Way at the above <br /> . � r Encroachment Permit;and <br /> 6 TW d fec ested,he agrees to do the work described in accordance with all terms,condition and restriction <br /> bis <br /> as general or special III provisions. <br /> ane of Ant True ate <br /> »»»»»>>>>>>»>>»»}»»»»»»»»»FIELD INSPECTION COMMENTS«««««««««««««««««««««< <br /> E)USTING CONDITIONS <br /> 1. DRIVEWAY. Norte ❑ Dirt ❑ Gravel ❑ Aggregate Base ❑ Paved(poor)it Paved(good) ❑ <br /> 2. SLOPING: Away,ftm Pavement ❑ Towards Pavement, Flat <br /> 3. PIPES: Notre TypeY� No Approaches Cross Drain Size <br /> O •p0eiv <br /> 4. HEADWALL: Yes ❑ No <br /> 5. ASPHALT CONCRETE DIKE: Yes 0 No <br /> 6. BARRIERS: al ,11 <br /> Right <br /> 7. DITCH: Yes ❑ No�ffyw. <br /> V Stye ❑ 2 Point ❑ Other ❑ Width Depth <br /> »>»»»>y»»>�,»>»»»»»»»»»»»»»»PERMITS REQUIREMENTS««««««««««««««««««««« <br /> 1. DRIVEWAY: SPRCommeraW ❑ Agriculture ❑ Industrial ❑ <br /> P "Min Depth A.C.over "Min Depth'/,"A.B.over <br /> Notes: <br /> of Pi Required Ft.and Diameter of Pipe inch(es) <br /> 2. PIPES: . Pe .th <br /> To beconnected to any adjacent driveway pipe Yes ❑ No <br /> Drainage Inlet Regoired Yes ❑ No <br /> Total Length: (with proposed) Total Number of Storm Drain Inlets: <br /> Notes: <br /> 3. HEADWALL: Yes ❑ No <br /> 4. PAVED FRONTAGE: Pam with 'Min Depth A.C.over "Min Depth'/,"A.B. <br /> Miring Feet in length and Feet in width <br /> »y»»»»»»>y»>y}»» »»»»»»»»»»»»»>FEES««««««««««««««««««««««««««« <br /> Driveway Eocroaehrrimt Permit base fee $125.00 <br /> $110.00 ❑ Paved Frontage $116.00+0.53/ft. <br /> 1 o $ <br /> �D!ivewWay179.00 Curb,Gutter,Sidewalk $113.00+1.08/ft. <br /> Cwt <br /> & WGOv. <br /> p� yp�Cy STER.pMCROA"EK PERMrr DRNEWAY.D(c (t0i09) Page 2 of 2 <br />