Laserfiche WebLink
THE APPLICANT HEREBY C .L.&TIFIES: <br /> 1.That he/she has read all the pmi 3s of this application,and that the description 'uded above are correct to the best of <br /> his/her knowledge,and <br /> 2.That he/she is the owns of the respective property.or is qualified to rep=ent the owner,and <br /> 3.That he/she will assume full responsibility for all liability for personal injury or damage to property which may arise out of <br /> the work described above,or which may arise out of his/her failure to do the work provided for herein;and <br /> 4.That in the event anv claim of such liability is made against the County of San Joaquin or any department,official or employee <br /> thereat he shall defend,indemnify and hold them and each of them harmless for such claim;and <br /> 5.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 valid San Joaquin County Encroachment Permit;and <br /> 6.That,if permission is granted as requested,he agrees to do the work described in accordance with all terms,conditions and <br /> restrictions of this andany sheet,included as general or special l 11 provisions. <br /> Signature of Applicant -Title Date <br /> FIELD INSPECTOR COMMENTS <br /> »»»»»»»»»» EXISTING 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 C>< Existing-Type <br /> Other pipes in neighborhood: Yes No Approaches Cross Drain Size <br /> Attachment to neighbor's pipe: es No <br /> 4. HEADWALL: Yes No� 5. ASPHALT CONCRETE DIKE: Yes Noc<" <br /> 6. BARRIERS along Right-Of--Way <br /> 7. DITCH Yes_N6�_ If Yes: V Style 2 Point_Other Width Depth <br /> »»»»»»»»»» PERMIT REQUIREMENTS «««««««««< <br /> 1. DRIVEWAY: SFR _ COMMERCIAL AGRICULTURE INDUSTRIAL <br /> PAVED with _ , 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 adjacen driveway pipe Yes No ' <br /> DRAINAGE INLET REQUIRED YES N <br /> Total Length: (with proposed) Total Number o Storm Drain Inlets <br /> Notes <br /> 3. HEADWALL Yes No <br /> 4. PAVED FRONTAGE: PAVED with " Min Depth A.0 over "Ivy Depth 3!4"A.B. <br /> measuring Feet in length and Feet in width <br /> FEES <br /> Encroachment Permit base fee . . . . . . . . . . . $40.00 <br /> Field Inspection <br /> DC3 Paved Frontage . . . . . . . . .$50.00 + .�S,ft <br /> Driveway w!or w/o pipe . . . . . . . $50.00 <br /> Driveway w/Box Culvert . . . . . . $80.00 Curb, Gutter, Sidewalk . . .$50.00+ .SOIft <br />