Laserfiche WebLink
TJHE, 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 />i f <br />3. That he/she will assume full responsibility for all liability for persona; injury or damage to properly 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 validalba uin County Encroachment Permit; and <br />6. That if permissi is granted a r steel, he agrees to do the work described in accordance with all terms, condition and restriction <br />of this and an attache h 1, ud d as general or special III provisions. <br />op <br />ig lure of Applicant Title Date <br />»»»»»»>»»>»»»»»»»»»»»>FIELD INSPECTION (OFFICE USE ONLY)««««««««««««««««««« <br />EXISTING CONDITIONS <br />1. DRIVEWAY: <br />2. SLOPING <br />3. PIPES: <br />None Dirt ❑ Gravel ❑ <br />Away from Pavement <br />Towards <br />None <br />Other pipes ii <br />4. HEADWALL: Yes r -1 <br />N <br />Aggregate Base ❑ Paved (poor) ❑ Paved (good) ❑ <br />Pavement ❑ Flat ❑ <br />5. ASPHALT CONCRETE DIKE: Yes ❑ No� <br />6. BARRIERS: along Right -of -Way <br />4 7. DITCH: Yes ❑ No 4 If Yes: V Style ❑ 2 Point E]Other F1Width Depth <br />»»»»>»»»»»�»((»»»»»>»>»»»»»»>PERMITS REQUIREMENTS««««««««««««««««««««« <br />1. DRIVEWAY: SFR & Commercial ❑ Agriculture F-1Industrial ElPaved with Z "Min Depth A.C. over,_"Min Depth %" A.B. over <br />Notes: <br />2. PIPES: Length of Pipe Required Ft. and Diameter of Pipe A inch(es) <br />To be connected to any adjacent driveway pipe Yes ❑ No <br />Drainage Inlet Required Yes ❑ No <br />Total Length: (with proposed) Total tuber of Storm Drain Inlets: <br />Notes: <br />3. HEADWALL: Yes ❑ No <br />4. PAVED FRONTAGE: Paved <br />Mwith "Min Depth A.C. over "Min Depth %" A.B. <br />easuring Feet in length and Feet in width <br />>»»»»»»»»»»»»»»»»»»»»>»»»»»»FEES««««««««««««««««««««««««««« <br />60 <br />Driveway Encroachment Permit base fee $135.00 <br />Field Inspection /) 2 <br />Driveway w/or w/o pipe $140.00 ® Paved Frontage $116.00+0.53/ft. <br />Driveway w/box Culvert __$181.00 Curb, Gutter, Sidewalk _$140.00 + 1.16/ft. <br />P VHGtOACHME1R5Waslx FamsiempUleaV <br />NCROACHNEMPERNRORNEWAY ea (C&90) <br />