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THE APPLICiU\'T HEREBY -RTIFIES: <br /> 1.That he/she has read all the pmvLions of[his application,and that the descriptions included above are correct to the best of <br /> his/her knowledge;and <br /> 2.That he/she is the owna of the respective property,or is quali:icd to rcprescat the owner,and <br /> 3.That be/she will assume full resp�ibility for all Eabiliy for personal injury or damage to property which may arise out of <br /> the wort,described above,or which may arise out of his/her failure to do the work provided for herein;and <br /> 4.That in the ev=t any claim ofss:ch liability is msde arpiimt the County of San Joaquin or any department,official or employee <br /> therco&he shall dcfLd,iadc=df}-and hold them a:d each of theca ha.�Iezz for such cla.ia;and <br /> S.That no work shall be performed by the applicant and/or any representatives of the applicant in the County Right-of-Way at <br /> the above indicated site without a vnL-id San Joaquin County Enaoachruent Permit;and <br /> 6.That,ifpenzission is granted as requested,he agrees to do the work dwatbed in accordance with all terms,conditions and <br /> restrictions of this and any attached sheet, included as ger aa1 or spo:ia1111 prrvisioas. <br /> Signature of Applicant -Title Date <br /> FIELD INSPECTOR CO--,Nn.-' IENTS <br /> »»»»»»»»»» EXISTE,'N G CONDITIONS «««««««««< <br /> 1. DRIVEWAY: None s�Dirt Gravel AQSecate Base Paved (Poor) Paved (Good)_ <br /> j2. SLOPPiG: Away from Pavement�_ Towards Pavement Flat <br /> 43. PIPES: None E-costing -Type <br /> Other pipes in neighborhood: Yes No Approaches Cross Drain Size <br /> Attachment to neighbor's pipe: Yes No <br /> 14. HEADWALL: :'es No 0�, 5. ASPFLA.LT CONCRETE DIKE: Yes Nq2� <br /> 6. BARRIERS along Right -Of-Way <br /> 7. DITCH Yes No If Yes: V Style 2 Point—Other Width Depth <br /> - »»»»»»»» >>> PERMIT REQUMMI ENTS «««««««««< <br /> 1. DRIVEWAY: SFR CO. 2 RCIAL AGRICUT.,TURE INDUSZRIAI. <br /> PAVED with _Z_"Min. Depth A.0 over -Min. Depth 3/4" A.B. <br /> ROCKED with " Min. Depth 3/4" A.B. <br /> Notes <br /> 2. PIPES: Length of Pipe Required: Ft. and Diameter of Pipe Inch <br /> To be connected to any adjacent driveway pipe Yes NO <br /> DR4LNAGE INLET REQULRED YES NOD(-- <br /> Total Length: (with proposed) Total dumber of Storm Drain Inlets <br /> Notes <br /> 3. HEADWALL Yes No <br /> 4. PAVED FRONTAGE- PAVED with 69— " titin. Depth A.0 over " Min. Depth 3/4" A.B. <br /> ulcasuring <br /> Fe--L in length and Feet is width <br /> FEES <br /> Facroachment Permit base fee . . . . . . . . . . . S40.00 <br /> .eld Inspection <br /> Driveway w/or w.�o pipe . . . . . . . $50.00 ❑ Paved Frontage . . . . . . . . .550.00 + .25/ft <br /> M Driveway w/Bos Culvert . . . . . . SS0.00 ❑ Curb, Gutter, Sidewall: . . .550.00 + .50/ft <br />