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 If provisions. <br />APPLICANT NOT PRESENT <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 ❑X <br />3. PIPES: None ® Existing — Type <br />Other pipes in neighborhood: Yes LJ No 0 Approaches Cross Drain Size <br />4. HEADWALL: Yes ❑ No M <br />5. ASPHALT CONCRETE DIKE: Yes ❑ No <br />6. BARRIERS: along Right -of -Way <br />7, DITCH: Yes ❑ No ® If Yes: V Style ❑ 2 Point ❑ Other ❑ Width Depth <br />»»»»»»»»»»»»»»»»»»»»»»»»PERMITS REQUIREMENTS««««««««««««««««««««« <br />1. DRIVEWAY: SFR ❑X Commercial ❑ Agriculture ❑ Industrial ❑ <br />Paved with 2 "Min Depth A.C. over 4 "Min Depth %" A.B. over <br />Notes: <br />2. PIPES: <br />Notes: <br />Length of Pipe Required <br />Ft. and Diameter of Pipe <br />N/A <br />Tobe connected to any <br />adjacent driveway pipe Yes ❑ <br />No <br />❑X <br />Drainage Inlet Required <br />Yes ❑ <br />No <br />Total Length: <br />(with proposed) <br />Total <br />Number of Storm Drain Inlets: <br />3. HEADWALL: Yes ❑ No <br />inches) <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 X <br />Field Ins ection <br />Driveway w/ or w/o <br />pipe $140.00 <br />Drivewayw/box Culvert $181.00 <br />PTNG2LALHMENibYMasle, Fwmsi"rt4Rka1ENCR0ACHAIEMPERMJTORNEWAYdoa(0Bp9) <br />Frontage <br />Curb, Gutter, Sidewalk <br />$116.00+0.531ft. <br />$140.00 <br />+ 1.16/ft. <br />BPaved <br />