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I. That he/she has read all the provisions of this application,and that the description,Included in this applicat are�to flti�I o f <br /> his/her knowledge;and , <br /> 2. That he/she is the owner of the respective property,or is qualified to represent itre Omer,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 Sanuin or any y departtt, cx eyee <br /> thereof,he shall defend,indemnify and hold them and each of them harmmless for such claim;and <br /> 5. That work shall be performed by the applicant and/or any representative of the application in the County *i- ayet flte <br /> abwe <br /> indicated site with a valid San Joaquin County Encroachment Permit;and <br /> 6. That if pe 'ssion is grante as requ ted,he agrees to do the work described accordance with all terms, and ram <br /> of this an y attache s t in eras cr speaat Ill provisions, <br /> Signa of App t <br /> »»»»»»»»»> »»»»»»»»»»>FIELD INSPECTION ComMENTS««««««««<<«««�««««<<<<, <br /> EXISTING CONDITIONS <br /> 1. DRIVEWAY: None [Dirt ❑ Gravel ❑ Aggregate Base E] Paved(poor) ❑ p (I ) ❑ <br /> 2. SLOPING: Away from Pavement 'Towards Pavement ❑ Flat <br /> 3. PIPES: Noneg Type <br /> ' <br /> Existin —T e <br /> Other pipes in neighborhood: Yes No Approaches Cross Drain Size <br /> 4. HEADWALL: Yes ❑ No 0311�` <br /> 5. ASPHALT CONCRETE DIKE: Yes ❑ No [ <br /> 6. BARRIERS: along Right-of-Way <br /> 7. DITCH: Yes ❑ No <br /> ❑ If Yes: V Style ❑ 2 Point ❑ Other <br /> »»>»»»»»»»»»»»»»»»»»»»»»>PERMITS REQUIREMIENTS««««««««««««««<c«««««« <br /> 1. DRIVEWAY: SFR ❑ Commercial ❑°± Agriculture ❑ Industrial ❑ <br /> Paved with "Min Depth A.C.over ' 'Min Depth 314"A.B.over <br /> Notes: <br /> v <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 /> Tota!Length: (with proposed) Total Number of Storm Drain Inlets: A <br /> Notes: <br /> 3. HEADWALL: Yes ❑ No <br /> 4. PAVED FRONTAGE: Paved with A "Min Depth A.C.over 'Min Depth Y47 A.B. <br /> Measuring Feet in length and Feet in width <br /> »»»»»»»»»»»»»»»»»»»»»»»»»»»FEES«««««««<z««««««««««««««««««« <br /> Driveway Encroachment Permit base fee $125.00 AZ o0 <br /> F' IcllnsDecfion <br /> Ed Driveway w/or w/o pipe $110.00 Paved frontage $116,00+0.5x <br /> 71 Driveway w/box Culvert $179.00 HCurb,Gutter,Sidewalk $113.00+1.08/ft. <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPU&SV.WKWUiSTER.PMNCROACHMENTPERMRDRIVEWAY.DOC (10109) Page 2ofy <br />