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 with 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,included as general or special III provisions. <br /> Signature of Applicant Title Date <br /> »»»»»»»»»»»»»»»»»»»»»>FIELD INSPECTION COMMENTS«««««««««««««««««««««< <br /> EXISTING CONDITIONS <br /> 1. DRIVEWAY: None ❑ Dirt ❑ Gravely Aggregate Base ❑ Paved(poor) ❑ Paved(good) ❑ <br /> 2. SLOPING: Away from Pavement ❑ Towards Pavement j. Flat <br /> 3. PIPES: None ❑ Existing—Type ' <br /> Other pipes in neighborhood: Yes No LJ Approaches LJ Cross Drain LJ Size J,' -< <br /> 4. HEADWALL: Yes ❑ No 2"' <br /> 5. ASPHALT CONCRETE DIKE: Yes ❑ No ®" <br /> 6. BARRIERS: along Right-of-Way <br /> 7. DITCH: Yes No ❑ If Yes: V Style a' 2 Point ❑ Other ❑ Width = Depth <br /> »»»»»»»»»»»»»»»»»»»»»»»»PERMITS REQUIREMENTS««««««««««««««««««««« <br /> 1, DRIVEWAY: SFR Commercial ❑ Agriculture ❑ Industrial ❑ <br /> Paved with v "Min Depth A.C.over "Min Depth 3/a"A.B.over <br /> Notes:, <br /> 2. PIPES: Length of Pipe Required F Ft.and Diameter of Pipe inch(es) <br /> To be connected to any adjacent driveway pipe Yes ❑ No <br /> Drainage Inlet Required Yes ❑ No <br /> Total Length: '` (with proposed) Total Number of Storm Drain Inlets: <br /> Notes: <br /> 3. HEADWALL: Yes ❑ No mak, <br /> 4. PAVED FRONTAGE: Paved with "Min Depth A.C.over "Min Depth S/4"A.B. <br /> Measuring Feet in length and Feet in width <br /> »»»»»»»»»»»»»»»»»»»»»»»»»»»FEES««««««««««««««««««««««««««« <br /> Driveway Encroachment Permit base fee $90.00 <br /> Field Ins ection <br /> LJ Driveway w/or w/o pipe $102.00 ❑ Paved Frontage $108.00+0.50/ft. <br /> Driveway w/box Culvert $167.00 Curb,Gutter,Sidewalk $105.00+1.03/ft. <br /> Y:V-0RMS&TEMPLATES\ENCRDACHMENT PERAMT DRVEWAY.doo�OBlOB) <br />