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 attached sheet, included as general or special III provisions. <br />Signature of Applicant Title Date <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 V1 <br />3. PIPES: None A Existing—Type <br />Other pipes in neighborhood: Yes LJ No LJ Approaches LJ Cross Drain Size <br />4. HEADWALL: Yes ❑ No <br />5, ASPHALT CONCRETE DIKE: Yes ❑ No <br />6, <br />BARRIERS: <br />7. <br />along Right -of -Way <br />DITCH: <br />Yes ❑ No � If Yes: V Style El <br />2 Point ❑ Other ❑ Width Depth <br />»»»»»»»»»»»»»»>»»»»>»»»»»PERMITS REQUIREMENTS««««««««««««««««««««« <br />1. DRIVEWAY: SFRkJ Commercial ❑ Agriculture ❑ Industrial ❑ <br />Paved with "Min Depth A.C. over "Min Depth 3/4" A.B. over <br />Notes: <br />2. PIPES: Length of Pipe Required Ft. and Diameter of Pipe inches) <br />To be connected to any adjacent driveway pipe Yes ❑ No <br />Drainage Inlet Required Yes ❑ No <br />Total Length: (with proposed) Tota mbar of Storm Drain Inlets: <br />Notes: <br />3, HEADWALL: Yes ❑ No <br />4. PAVED FRONTAGE: Paved with "Min Depth A.C. over " Min Depth W A.B. <br />Measuring Feet in length and Feet in width <br />>»»»»»»»»»>»»»»»»»»»»»»»»»»»FEES««««««««««««««««««««««««««« <br />Driveway Encroachment Permit base fee $140.0 <br />Field Ins ection <br />Driveway w/ or w/o pipe $140.0 B Paved Frontage $116.00 + 0.53/ft. <br />rrvewayw/box Culvert $181.00 Curb, Gutter, Sidewalk $140.00+1.16/ft. <br />XIENCROACHMENISW.ash, rwmsienIMRsIENCROACHMEW PERMIT DRN5WAY&o(MR) <br />