PS-2302675 - Laserfiche WebLink

Home Browse Search

THE APPLICANT nEREBY CERTIFIES: 1. That halshe has read all the provisions of this application, and that the description included in this application are correct to the best of hislher�klrowledge; and 2. That bq(sbe is the,owner of the respective property, or is qualified to represent the owner; and 3. That he/she will assume full responsibility for all liability for persona; injury or damage; -to propeAywhich mayy arise out of the work described above, or which may arise out of his/her failure to do the work provided herein; and 4. That in the event any claim of such liability is made against the County of San Joaquin or any department, official or employee thereof, he shall defend, indemnify and hold them and each of them harmless for such claim; and 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 indicated site with a va<id San, Joaquin County,Fncroachment Permit; and 6. That if permission is granted as requested; he agrees to do the work described in accordance with all terms, condition and restriction of this and any attached sheet, included as general or special III provisions. // , % ,.`t Signature of Applicant Title >»»»»»»»» »» »»»>»»»»»>>>FIELD EXISTING INSPECTION (OFFICE USE ONLY)««««««««««««««««««« 1. DRIVEWAY: r-1 Paved (good) F-1 None IJ Dirt ❑ Gravel ❑ Aggregate Base ❑ Paved (poor) 2. SLOPING: Away from Pavement ❑ Towards Pavement r-1Flat d 3. PIPES: None Existing oItNpe roaches Cross Drain Size Other pipes in neighborhood: Yes No App 4. HEADWALL: Yes ❑ No [_✓I 5, ASPHALT CONCRETE DIKE: Yes ❑ No L✓J 6. BARRIERS: along Right -of -Way 7, DITCH: Yes E] No [Z If Yes: V Style ❑ 2 Point ❑ Other ❑ Width Depth »»» >»»»»»>»»»»»>»»»»>»»»»»PERMITS REQUIREMENTS««««««««««««««««««««« 1, DRIVEWAY: SFR V Commercial ❑ Agriculture ❑ Industrial ❑ Paved with �L "Min Depth A.C. over 'i "Min Depth %;' A.B. over Notes: 2. PIPES: Length of Pipe Required NA Ft. and Diameter of Pipe n�A inch(es) To be connected to any adjacent driveway pipe Yes ❑ No Drainage Inlet Required Yes ❑ No Total Length: /\/ A (with proposed) Total Number of Storm Drain Inlets: Notes: 3. HEADWALL: Yes ❑ No [� "Min De th A.C. over "Min Depth %" A.B. 4. PAVED FRONTAGE: Paved with p Feet.in width Measuring Feet in length and »»»»>»»»»» »»»>» »»»»»»»»»»>>>>FEES«««<L««««««««««««««««««««««« Driveway Encroachment Permit base fee $140.00 Field Ins ection 140.00 e Paved Frontage $116.00 + 0.53fft. Driveway w/ or w/o pipe $181.00 Curb, Gutter, Sidewalk $140,00 + 1.16/it. Driveway w/box Culvert $ XIEH[HOPCHAIININAes@,Fw TOWWWEKGRWHWI PFAMR wWEM'AY.do"(0M