Laserfiche WebLink
!•H' : `"'LICANT HEREBY CERTIFIES'- <br /> ,2t e / she has read all the provisions this application, and that the descriptior .:!uded abova are correct <br /> the best of his / her knowledge; and ' <br /> 'hat he / she is the owner of the respective property, or is qualified to represent the oh•-er, and <br /> hat he / she will assume full responsibility for all liability for perso, in�urr or Crnage :� property which may <br /> arise out of the worts described above, or which may arise out of his/ her failure to do the work provided for <br /> -erein: and <br /> -hat in the event any claim of such liability is made against the County of San Joaquin or any department, <br /> --tficial or employee thereof, he shall defend, indemnify and hold them and each of them harmless for such claim; <br /> and <br /> That no work shall be performed by the applicant and / or any representatives of the applicant in the County <br /> Right-of-Way at the above indicated site without a valid San Joaquin County Encroachment Permit; and <br /> That, if permission is granted as requested, he agrees to do the work described in accordance with all terms, <br /> conditions and restrictions of this and any attached sheet, included as general or special provisions. <br /> Sig ture of Applicant -Title Da e <br /> FIELD INSPECTOR COMMENTS <br /> »»»»»»»»»»»»>E ISTING CONDITIONS«««««««««««< <br /> DRIVEWAY: None Dirt Gravel Aggregate Base Paved(Poor) Paved(Good) <br /> SLOPING: Away from Pavement Towards Pavement-14 Flat <br /> PIPES: Non;2L Existing -Type <br /> Other pipes in neighborhood: Yes NoXApproaches Cross Drain Size <br /> Attachment to e�ghbor's pipe: Yes No i� <br /> HEADWALL: Yes N <br /> ASPHALT CONCRETE DIKE: Yes No_ <br /> BARRIERS along Right-of-Way <br /> DITCH Yes No,- If Yes: V Style_ 2 Point_ Other Width_ Depth <br /> »»»»»»»»»»»»>P E R M I T R EQ U I R E M E NTS««««««««««««< <br /> DRIVEWAY: SFR_C2�,COMMERCIAL AGRICUL RE INDUSTRIAL <br /> PAVED with 2" Min. Depth A.C. over ' Min Depth 314" A.B. <br /> or <br /> 4" Min. Depth Portland Cement Concrete. <br /> '.es: <br /> PIPES: Length of pipe Required: See Form R-17, Note 4 Diameter of Pipe Inch <br /> To be connected to any adjacent driveway pipe Yes N04—o" <br /> DRAINAGE INLET REQUIRED Yes No <br /> Total Length: (with proposed) Total Num er of Storm Drain Inlets <br /> •.es: <br /> 1EADWALL Yes Nom. <br /> SAVED FRONTAGE: PAVED witrWin. Depth A.C. over " Min. Depth 314"A.B. <br /> measuring Feet in length and Feet in width <br /> FEES <br /> -oachment Permit base fee . . . . .S4`-00 <br /> Inspection <br /> Driveway wl or w,`o pipe . . . . .S5^.^0 Paved Frontage . . . . . . . . S50.00 + .25/ft <br /> Driveway w/ Box Cv!vert . . . . c . 00 Curd, Gutter, Si�e.valk . . .550.00 + .SO/ft <br />