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1.- 7118thiNfshellmlead all fie provisions of this app cation,and that the descriptim included in this application are correct to the hest 01 { - <br /> 2: TI is Uoxm of the Vie,property,or is qualified to represent the owner,and <br /> 3. That hamie wommm M responsibillity for all Uabft for persona;injury or damage to property which may arise out of the work <br /> d8swbed abM,or whkh may ar out of hMw failure to do the work provided herein;and <br /> 4. Theit.ift.theev ta€ry daim of such r is made against the Gounty'of San Joaquin or any department,official or employee <br /> ter he ShM did; �anit hold Own and each of them harmless for such claim;and <br /> 5. That i s Wby the t arKft any representative of the application in the County Right-of-Way at the above <br /> s t ! ty Ehdroadiment Permit;and <br /> S. That if S",Is granted as ,he agrees to do the work described in accordance with all terms,condition and restriction <br /> awl an as general or special III provisions. <br /> D&"n OtAplplidarifTtfle ate �( <br /> INSPECTION COMMENTS«««««««««««««««««««««< <br /> IDMING CONDITIONS <br /> 1. DRIVEWAY: Nolle❑ Dirt 0"'Gravel ❑ Aggregate Base ❑ Paved(poor) ❑ Paved(good) ❑ <br /> 2. SLOPING. Away from Paimnerit Towards Pavement ❑ Flat <br /> 3. PIPES: Note Exisfng—Type <br /> 664-pYes Ne Approaches U Cross min U Size <br /> 4. HEADWALL- Yes ❑ No Q' <br /> 5. ASPHALT CONTE DIKE- Yes ❑ No <br /> BARRIERS: -of-Way <br /> ,7. DftH: Yes No gelf Yes: VStyle ❑ 2 Point ❑ Other ❑ Width Depth <br /> »»»»» »»> »»»»»»»»»»»»»»»>PERMITS REQUIREMENTS««««««««««««««««««««« <br /> 1. MVEWAY; SFR Corremer ❑ Agriculture ❑ Industrial <br /> PAVI ed>ht '" 'Min.Depth A.C.over . Min Depth W A.B.over <br /> Nates: t4 � .-J .e0444 /01 <br /> d <br /> 2. PIPES: Lit of Pipe Required Ft and Diameter of Pipe , . inch(es) <br /> To be awmW to any a*,mt driveway pipe Yes ❑ No <br /> gage Ind ReWed Yes ❑ No <br /> Total Length: (with proposed) Total Number of Storm Drain Inlets: <br /> Notes: <br /> 3. HEADWALL: Yes ❑ No <br /> 4. PAVED FROWAGE: Paved with W114 "Min Depth A.C.over °Min Depth3/4"A.B. <br /> Measuring Feet in length and Feet in width <br /> »»»»»»»»»»»3»»»»»»»»»»»»»»»>FEES««««««««««««««««««««««««««« <br /> Driveway dement Permit base fee $125.00 <br /> Field <br /> or wJo pipe $110.00 ❑ Paved Frontage $116.00+0.53/ft. <br /> Driveway wJbox Qhert $179.00 Curb,Gutter,Sidewalk $113.00+1.08/ft. <br /> 1/. WBb1# PEFMUDRNEWAYIM (100) Page 2of2 <br />