Laserfiche WebLink
1. That he/she has read all the provisions of this application,and that the description included in this application are correct to the best 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 assume full 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 claim of such liability is made against the County of San Joaquin or any department;official or employee <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 and/or any representative of the application in the County bight-of-Way at the above <br /> indicated site with a valid 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 aU terms,condition and restriction <br /> of this and an s t,included as general or special III provisions. <br /> //'-SigAefure-of Applicdnt Tike ate <br /> >>>>>>>>>>>>>>>>>>>>7 <br /> »»»»»»»»» »»»»»»»»»»>FIELD INSPECTION COMMENTS«««««««««««««««««««««< <br /> EXISTING CONDITIONS <br /> 1. DRIVEWAY: None ❑ Dirt ❑ Gravel ❑ Aggregate ;7'oFlat <br /> Paved(poor) W/Paved(good) <br /> 2. SLOPING: Away from Pavement F-1 TowardsPavement <br /> 3. PIPES: None ❑ Existing—Type 19 <br /> Other pipes in neighborhood. Yes b/ No Approaches Cross Drarn e <br /> 4. HEADWALL: Yes ❑ No <br /> 5. ASPHALT CONCRETE DIKE: Yes ❑ No <br /> 6. BARRIERS: along Right -Way <br /> 7. DITCH: Yes No ❑ If Yes: V Style ❑ 2 Point Other W <br /> � ❑ � Width Depth <br /> »»»»»»»»»»»»>»»»»»»»»»»»>PERMITS REQUIREMENTS«««««««e«««««««««««««< <br /> 1. DRIVEWAY: SFR ❑ Commercial [ Agriculture ❑ Industrial ❑ <br /> Paved with "Min Depth A.C.over__"Min Depth%'A.B.over <br /> Notes: <br /> 2. PIPES: Length of Pipe Required Ft.and Diameter of Pipe j ,1 GrP inch(es) <br /> ) <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 ❑ <br /> 4. PAVED FRONTAGE: Paved with "Min Depth A.G.over "Min Depth 3/4'A.B. <br /> Measuring Feet in length and Feet in width <br /> »»»»»»»»»»»»»»»»»»»»»»»»»»»FEES««««««««««««««««««««««««««« <br /> Driveway Encroachment Permit base fee $125.00 <br /> Field InsDection <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.ORGISNARESICENTRALSERVICESICLERICALIPUBSV.WKWASTER.PSIENCROACHMENTPERb9TDRIVEWAY.DOC (1 09) Page gofp <br />