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1 Thattgowtwiead.zilt,theprovisions of this motion,and that the description included in this application are correct to the best of <br /> Il�d�e <br /> 2 Thatis 0f the respecUm property,or is qualified to represent the owner;and <br /> 3• rr+ r � � for Irsona;injury or damage to property which may arise out of the work <br /> d awe out of# s f #ure td do the work provided herein;and <br /> 4 of m,4hkbft is made against the County of San Joaquin or any department,official or employee <br /> ¢ 4 <br /> h6ld'them and each of them harmless for such claim;and <br /> 5 ar4(or any representative of the application in the County Right-of-Way at the above <br /> Eraroachment Permit;and <br /> 6rled,he°awes to do the work described in accordance with all terms,condition and restriction <br /> ,d or special III provisions. <br /> / <br /> T*� ate <br /> »»>>»>>>yy»»>»»» ,»»»»»»»»>EaDM CTION COMMENTS«««««««««««««««««««««< <br /> EXlS"1`ING CONDITIONS <br /> 1. DRIVEWAY None W,"'Dit ❑ Gravel ❑ AggiegateBase ❑ Paved(poor) ❑ Paved(good) ❑ <br /> 2. SLOPING: AWW from Pa"uertt ❑ Tods Pavement [] Flat <br /> 3. PIKES: New —Type <br /> tom: Yes U No LwJ Approaches Cross Drain Size <br /> 4. HEA , ALL: Yo ❑ <br /> 5. ASPHALT CON RET tk: Yes 0 No <br /> 6• BARKERS: _ n <br /> 7. DITCH: Yes ❑ No �Y�: VStyle ❑ 2 Point ❑ Other ❑ Width Depth <br /> >>>y,,,»»»»»»>»»>y»»»»»>>»»»»»»PERMITS REQUIREMENTS««««««««««««««««««««« <br /> 1. DRIVEWAY: SFR ISS mal ❑ Agriculture ❑ Industrial <br /> Paved With 'r --"Win Depth A.C.over "Min Depth%"A.B.over <br /> Notes: <br /> ...,�. <br /> 2. PIPES: Lefvh of Pipe Required A.0/ inches Ft.and Diameter of Pipe inch(es) <br /> To be cotnectati to any adjacent driveway pipe Yes ❑ No f <br /> Dr age W kequlred Yes ❑ No [� <br /> TOW Length: - '" (with proposed) Total Number of Storm Drain Inlets: <br /> Notes: <br /> 3. HEADWALL: Yes ❑ No <br /> 4. PAVED.FROI TAGE: Paved with A "Min Depth A.C.over "Min Depth'/<"A.B. <br /> M"W" Feet in length and Feet in width <br /> »»»»>>>»»y>,»»>y»»»»»»»»»y»»»»»»FEES««««««««««««««««««««««««««« <br /> Driveway Erwvdvnent Pett bM $125.00 <br /> For Paved Frontage $116.00+0.531ft. <br /> 13t�;►ew wax <br /> ya $11000 ❑ Curb,Gutter,Sidewalk $113.00+1.08/ft. <br /> ; Crilwett $179:00 <br /> ` IP4 .NlKYiASfFR PSi@iCROAGIiIENl PERMR DRNEWAY.DDC (10109) Page 2 of 2 <br />