Laserfiche WebLink
THE APPLICANT HEREBY CERTIFIES: <br />1. That he/she has read all the provisions of this application, and that the description included in this application are coned to the best of <br />his/her knowledge; and <br />2. That helshe 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 adse 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 Right -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 all terms, condition and restriction <br />of is and any attached she included as general or special III provisions. <br />err<3-GL <br />ignature of Appli t Title Date <br />»»»»»»» > »»>>>>»»>>>>»»>»FIELD INSPECTION (OFFICE USE ONLY)c«<e««<<<<«««««a<«««««« <br />EXISTING CONDITIONS <br />1. DRIVEWAY: None ❑ Did ❑ Gravel ❑ Aggregate Base ❑ Paved (poor) ® Paved (good) ❑ <br />2, SLOPING: Awayfrom Pavement ❑ Towards Pavement ❑ Flat <br />3. PIPES: None ❑ Existing — Type 12" <br />Other pipes in neighborhood: Yes E No Approaches E Cross Drain Size <br />4. HEADWALL: Yes ❑ No Pq <br />5. ASPHALT CONCRETE DIKE: Yes ❑ No Pq <br />6. BARRIERS: along Right -of -Way <br />7. DITCH: Yes ® No ❑ If Yas: V Style ❑ 2 Point ❑ Other ❑ Width <br />Depth <br />»»»>»»>» »»»»»» »»»»>»»»»»»>PERMITS REQUIREMENTS««««««u««<<<<a««««««««« <br />1. DRIVEWAY: SFR ❑ Commercial ® Agriculture ❑ Industrial ❑ <br />Paved with 2 "Min Depth A.C. over 6 "Min Depth W A.B. over <br />Notes: <br />2. PIPES: Length of Pipe Requimd Ft and Diameter of Pipe 12 inches) <br />To be connected to any adjacent driveway pipe Yes ❑ No <br />Drainage Inlet Required Yes ❑ No ❑X <br />Total Length: (with proposed) Total Number of Sloan Drain Inlets: <br />Notes: <br />3. HEADWALL: Yes ❑ No X❑ <br />4. PAVED FRONTAGE: Paved with "Min Depth A.C. over ' Min Depth'/.' A.B. <br />Measuring Feet in length and Feet in width <br />»»»>»»»» »»»»»>»»>>>>>>>»»»»»»>»» FEES««««««««««««««««««««««««««« <br />Driveway Encroachment Permit base fee_$135.00 <br />Field Ins action <br />Driveway wl or wlo pipe $140.00 <br />Driveway wlbox Culvert $181.00 <br />HPaved Frontage $116.00+0.531ft. <br />Curb, Gutter, Sidewalk $140.00+1.16/ft. <br />