Laserfiche WebLink
THE APPLICANT HEREBY CERT"IFIES: - , <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 />hislher knowledge; and <br />2, That helshe is the owner of the respective property, oris qualified to represent the ovdner; and <br />3, That helshe 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 hislher 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 he performed by the applicant andlor any representative of the application in fhe 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 re ted; he agrees to do the work described in accordance with all terms, condition and restriction <br />of this and any attached shee�in Jude as general or special III provisions, <br />� ����� <br />Signature of Applicant Titre Date <br />»»»»»»»»»»»»»»»»»»»»> FI L-l.D I NS PECTION (OFFICE USE ONLY)««««««««««««««««««« <br />EY.ISTING CONDITIONS <br />1. DRIVEWAY: None ❑ Dirt �. Gravel ❑ Aggregate Base ❑ Paved (poor) ❑ Paved (good) ❑ <br />2. SLOPING; Away from Pavement ❑ Towards Pavement ❑ Flat <br />3. PIPES; None ❑ Existing—Type i2�' Gor2Rti6�aT�� EL <br />Other pipes in neighborhood; Yes No Approaches Cross Drain Size 1 <br />4. HEADWALL; Yes ❑ No ��-- <br />5. ASPHALT CONCRETE,DIKE; Yes ❑ No � . <br />6. BARRIERS: along Right -of -Way <br />7, DITCH: Yes [6� No ❑ If Yes: V Style ❑ 2 Point ❑ Other ❑ Width Depth <br />»»»»»»»»»»»»»»»»»»»»»»»»PERn41TS REQUIREII4ENTS««««««««««««««««««««« <br />1. DRIVEWAY; SFR � Commercial ❑ <br />Paved with 'L' <br />Notes; <br />2. PIPES; Length of Pipe Required <br />Notes; <br />Agriculture ❑ Industrial ❑ <br />"Min Depth A.C, over <br />"Min Depth'/a' A,B, over <br />Ft. and Diameter of Pipe � Z �� <br />To be connected to any adjacent driveway pipe Yes ❑ No <br />Drainage Inlet Required Yes ❑ No <br />Total Length; (with proposed) Total Number of Storm Drain Inlets: <br />3. HEADWALL: Yes ❑ No �,,, <br />inches) <br />4. PAVED FRONTAGE: Paved vdith "Min Depth A.C, over "Min Depth'/q° A.B. <br />Measuring Feet in length and Feet in width <br />»»»»»»»»»»»»»»»»»»»»»»»»»»»FEL=S««««««««««««««««««««««««««« <br />Driveway Encroachment Permit base fee $135,00 <br />Field Ins ection <br />Driveway wl or wlo pipe $140,00 <br />Driveway w/box Culvert $181,00 <br />P:IEWCROACNtJfWT511daslar Fomis-Templalesic'NCROACHMEM PERMIT DRIVEINAY.da (79108) <br />❑Paved Frontage $116.00 + 0,53/ft, <br />Curr, Gutter, Sidewalk $140,00+'I,'161ft, <br />