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...-... �.v..... ..�.. �✓. v1�1�I it ILV. <br /> 1. That he/she has read all the provisionsf this a ` and t# t tf�e <br /> his/her knowledge;andtfappfito :ati� d 7 <br /> 2. That he/she is the owner of the respective propefty,or is,quafi #to refreserrt the,ower;and <br /> 3. That he/she will assume full responsibilty for au#amity fol•persona;injury or dmrtage th <br /> described above,or which may arise out of hisr failure to do the work �;anti out <br /> 4. That in the event any claim of such kty is made against the Coen of San <br /> or <br /> thereof,he shalt defend,indemnify and hcdale° <br /> d them and each of#»r harxrlss fes }and <br /> 5. That work shall be performed by the app►icant and/or any reprove of if 'ort' <br /> indicated site with a valid San Joaquin County Encroachm t POin€t;and µ. <br /> 6. That if permission is granted as requested,fees to do the mrk desmbed in ice a <br /> of this and any attached sheet,' as mal or n' <br /> speaaf fit proviskins. <br /> Signature of <br /> r9na Applicant Tit{e <br /> »»»»»»»»»»»»»»»>»»»»»»FIELt? lSf'ECTPN COWAM<1 ccc<c<ccc«<ccc c c ccctc cat cc <br /> EXiS"ifNC G�t'1t��5 <br /> 1. DRIVEWAY: None ❑ Dirt ❑ Gravel [j' Aggregate Base FPaved£t1 ❑ Paved-(good),❑ <br /> 2. SLOPING: Away from Pavement ❑ Towards Pavement ❑ Fiat <br /> 3. PIPES: None [Existing—Type "" <br /> Other pipes in neighborhood: Yes No ApproachesCross fin Size <br /> 4. HEADWALL: Yes ❑ No (ice" <br /> 5. ASPHALT CONCRETE DIKE: Yes ❑ No <br /> 6. BARRIERS: along Right-of-Way ; <br /> 7. DITCH: Yes ❑ No v ,r Yes: V Stye ❑ 2 Point ❑ Other ❑ Wift Depth <br /> »»»»»»»»»»»»»»»»»»»»>»»»>PERMrrS f �Rfitllr cc«cc«<c««c«<c«c tc <t«ccc« cS <br /> 1. DRIVEWAY: SFR Commercial ❑ Agriculture ❑ Industrial <br /> Paved with "Min Depth A.C.over " <br /> . ._.._ Min Depth A.S.ow <br /> Notes: " O, <br /> x' <br /> 2. PIPES: Length of Pipe Required + , Ft,and Diameter.of pipe <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;k*ts: <br /> Notes: <br /> 3. HEADWALL: Yes ❑ No <br /> 4. PAVED FRONTAGE: Paved with `f` A.C. . ,t Depth <br /> Y4* <br /> A.B.y,y " ...Depth ACQ1tef Mari�%"T <br /> Measuring Feet in length and Feet in uta <br /> »»»»»»»»»»»»»»»»»»»»»»»»»a»>PEt <br /> Driveway Encroachment Permit base fee $125. <br /> Field fns cion <br /> Driveway w/or w/o Pipe $110.00 Paved From $1Fi1Q p <br /> Driveway w/box Culvert $179.00 ❑ Curb,Gutter, 1, <br /> OW <br /> k1SJPWGOV.ORGSHARESICENTRALSERVICE=LERICALnB-SV.WKVAASTER.PS84CROA P,19W DW6WAY.00C JIM.. Pap2oQ <br />