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 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 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 this and any at d sheet, included s general or special III provisions, <br />ature of ApplicantTiller ate <br />»»»»»»»»>»»>»»»»»»»»»>FIELD INSPECTION (OFFICE USE ONLY)««««««««««««««««««« <br />EXISTING CONDITIONS <br />1. DRIVEWAY: None � Dirt ❑ Gravel ❑ Aggregate Base ❑ Paved (poor) ❑ Paved (good) ❑ <br />2. SLOPING: Away from Pavement ❑ Towards Pavement ❑ Flat it <br />3. PIPES: None rA <br />Existing —Type <br />Other pipes in neighborhood: Yes 12Q. No LJ Approaches 44 Cross Drain Lj Size,_ <br />4, HEADWALL: Yes ❑ No< <br />5. ASPHALT CONCRETE DIKE: Yes ❑ No ❑ <br />6. BARRIERS: along Right -of -Way <br />7. DITCH: Yes �I No ❑ If Yes: V Style ❑ 2 Point ❑ Other ❑ Width Depth <br />»»>»»»»»»»_>`>>>>>>»»»»»»»>»»»>PERMITS REQUIREMENTS««««««««««««««««««««« <br />1, DRIVEWAY: SFR#J. Commercial ❑ Agriculture ❑ Industrial ❑ <br />Paved with h "Min Depth A.C. over "Min Depth %" A.B. over <br />tr <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 KI <br />�! Total Length: ! � (with proposed) Total Number of Storm Drain Inlets: LL <br />Notes: AF ZtL+cnaiKi Alklt D✓bi�3��Cli/t/CN/c+Sl /5 TOG i T�G'Du�6� <br />3. HEADWALL: Yes ❑ No� <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 />>»»»>»»»»»»>>>>>>>»»>»»»>m»»»»»>>FEES««««««««««««««««««««««««««« <br />Driveway Encroachment Permit base fee $135.00 <br />Field Ins action <br />Driveway w/ or w/o pipe $140.00a Paved Frontage $116.00 + 0.53/ft. <br />Driveway w/box Culvert $181.00 Curb, Gutter, Sidewalk $140.00 + 1.16/11. <br />P^TNMCALHMEWS MFm TaryktmCWRMDHM WPERMIT DRWE AYE (NMI <br />