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 prope(ty 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 nd as requested, he agrees to do the work described in accordance with all terms, condition and restriction <br />of this and any atta ped eet, included as general or special III provisions. <br />/ ature of BOicant Title Date <br />INSPECTION (OFFICE USE ONLY)«««u««««««««««««««« <br />EXISTING CONDITIONS <br />1. DRIVEWAY: None ❑ Dirt ❑ Gravel ❑ Aggregate Base ❑ Paved (poor) ❑ Paved (good) ❑ <br />2. SLOPING: Away from Pavement ❑ Towards Pavement ❑ Flatx0 <br />3. PIPES: None � Existing —Type <br />Other apes in neighb rhood: Yes Lj <br />4. HEADWALL: Yes ElNo7 <br />5, ASPHALT CONCRETE DIKE: Yes ❑ No f� <br />6. BARRIERS: along Right -of -Way <br />7. DITCH: Yes ❑ No If Yes: V Style ❑ <br />1. DRIVEWAY: SFR <br />Paved with <br />Notes: <br />Commercial ❑ <br />Z <br />2. PIPES: Length of Pipe Required <br />Notes: <br />No Approaches Cross Drain Size <br />2 Point ❑ Other ❑ Width <br />Depth <br />PERMITS REQIJIREOIIENTS««««««««««««««««««««« <br />Industrial F1 <br />Agriculture ❑ <br />"Min Depth A.C. over 41 <br />To be connected to any adjacent driveway pipe Yes ❑ <br />Drainage Inlet Required Yes ❑ <br />Total Length: (with proposed) <br />3. HEADWALL: Yes ❑ No <br />"Min Depth'/" A.B. over <br />Ft. and Dia eter of Pipe <br />No <br />No <br />Total Number of Storm Drain Inlets: <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 <br />Field Ins ection <br />Driveway wl or w/o <br />pipe $140.00 <br />Drivevday wlbox Culvert $181.00 <br />P:IEIJCROACH�NENTSWaster Fans-TempleleslENC ROACHM1IENT PERMIT ORIVENIAY.dac (00100) <br />®Paved Frontage $116,00 + 0.531ft. <br />Curb, Gutter, Sidewalk $140.00 .t 1.16/ff. <br />