Laserfiche WebLink
THE APPLICANT HEREBY CERTIFIES: <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 /> 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 persona;injury or damage to property which may arise out of the work <br /> described above,or which may arise out of his/her 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 be performed by the applicant and/or any representative of the application in the 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 requested,he agrees to do the work described in accordance with all terms,condition and restriction <br /> of this and any attached sheet, f ded as general or special III provisions, <br /> 'Signature of ApplidantlTitle I pate <br /> »»»»»»»»»»»»»»»»»»»»>>>FIELD INSPECTION COMMENTS«««««««««««««««««««««< <br /> EXISTING CONDITIONS <br /> 1. DRIVEWAY: None EY Dirt ❑ Gravel ❑ Aggregate Base ❑ Paved(poor) ❑ Paved(good) ❑ <br /> 2. SLOPING: Away from Pavement [Towards Pavement ❑ Flat ❑ <br /> 3. PIPES: None E Existing—Type IJ <br /> Other pipes in neighborhood: Yes No Approaches LJ Cross Drain LJ Size <br /> 4. HEADWALL: Yes ❑ No <br /> 5. ASPHALT CONCRETE DIKE: Yes ❑ No ❑ <br /> 6. BARRIERS: along Right-of-Way <br /> 7. DITCH: Yes ❑ No If Yes: V Style ❑ 2 Point ❑ Other ❑ Width Depth <br /> »»»»»»»»»»»»»»»»»»>»»»»»>PERMITS REQUIREMENTS««««««««««««««««««««« <br /> 1. DRIVEWAY: SFR Commercial ❑ Agriculture ❑ Industrial ❑ <br /> Paved with 2' "Min Depth A.C.over ( "Min Depth%4'A.B.over <br /> Notes: Ci q�di;rr ct�/�-/� 5'.J Cd �12i�� , U,�cf 5- <br /> 2. PIPES: Length of Pipe Required Ft.and Diameter of Pipe inch(es) <br /> To be connected to any adjacent driveway pipe Yes ❑ No Eq'— <br /> Drainage <br /> q'—Drainage Inlet Required Yes ❑ No D-- <br /> Total Length: <br /> -'TotalLength: / (with proposed) Total Number of Storm Drain Inlets: <br /> Notes: Z,Cel 74, CfGc�/s, G(✓ L�KiS>� 5��.� _ <br /> J <br /> G'�7/���j�f/7t�y� ct� E�/�1e'�✓�� LJ�rI� �'�i<�Si/�c�✓! 6��a"�� `-�' Y�/L�/,r7� . <br /> 3. HEADWALL: Yes ❑ No [� <br /> 4. PAVED FRONTAGE: Paved with �� "Min Depth A.C.over "Min Depth%"A.B. <br /> Measuring Feet in length and Feet in width <br /> »»»»»»»»»»»»»»»»»»»»»»»»»»»FEES««««««««««««««««««««««««««« <br /> Driveway Encroachment Permit base fee $135.00 <br /> Field Inspection <br /> Driveway w/or w/o pipe $121.00 Paved Frontage $116.00+0.53/ft. <br /> Driveway w/box Culvert $181.00 8 Curb,Gutter,Sidewalk $121.00+1.16/ft. <br /> M:ICEN RALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENTPERMIT DRIVEWAY.DOC (09/13) Page 2of2 <br />