Laserfiche WebLink
THE APPLICANT HEREBY CERTIFIEQ- <br />1. That he / she has read all the provision ii ;:,is application, and that the descriptior. icluded above are correct <br />to the best of 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 personal injury or dmage to property which may <br />arise out of the work described above, or which may arise out of his / her failure to do the work provided for <br />herein; and <br />4. That in the event any claim of such liability is made against the County of San Joaquin or any department, <br />official or employee thereof, he shall defend, indemnify and hold them. and each of them harmless for such claim; <br />and <br />5. That no work shall be performed by the applicant and / or any representatives of the applicant in the County <br />ht -of -Way at the above indicated site without a valid San Joaquin County Encroachment Permit; and <br />6. t, if permission is granted as requested, he agrees to do the work described in accordance with all terms, <br />co ditions and restrictions of this and any attached sheet, included as general or special provisions. <br />nature of Applicant - Title Date <br />FIELD INSPECTOR COMMENTS <br />1. DRIVEWAY: <br />»»»»»»»»»»»»>EXISTING CONDITIONS«««««««««««< <br />Non Dirt Gravel Aggregate Base Paved(Poor)Paved(Good) <br />2. SLOPING: <br />3. PIPES: <br />Away from Pavement Towards Pavement Flat <br />None Existing - Type <br />Other pipes in neighborhood: Yes No -Approaches Cross Drain Size <br />Attachment to neighbor's pipe: Yes 4 <br />4. HEADWALL: Yes No ''. <br />5. ASPHALT CONCRETE DIKE: Yes Noa� <br />6. BARRIERS <br />along Right-of-Vyay <br />7. DITCH <br />Yes N If Yes: V Style_ 2 Point_ Other Width_ Depth <br />»»»»»» »»»»»»PERMIT REQUIREMENTS««««««««««««< <br />1. DRIVEWAY: SFR COMMERCIAL AGRICUL URE INDUSTRIAL <br />PAV D with 2" Min. Depth A.C. over " Min Depth 3/4" A.B. <br />or <br />4" Min. Depth Portland Cement Concre e. <br />Notes: <br />2. PIPES: <br />Length of pipe Required: See Form R-17, Note 4 Diameter of Pipe Inch <br />To be connected to any adjacent driveway pipeY NcV <br />DRAINAGE INLET REQUIRED Yes No <br />Total Length: (with proposed) Total Number of Storm Drain Inlets <br />Notes: <br />3. HEADWALL <br />4. PAVED FRONTAGE: <br />Yes N6 <br />PAV with " Min. Depth A.C. over " Min. Depth 3/4" A.B. <br />measuring Feet in length and Feet in width <br />FEES <br />ment Pbffhit base fee .....$40.00 <br />'In spection <br />Driveway <br />w/ or w/o pipe .....$50.00 Paved Frontage ........ $50.00 + .25/ft <br />Driveway w/ Box Culvert .... $80.00 Curb, Gutter, Sidewalk ...$50.00 + .50/ft <br />