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THE AP€'LICAWNEREBY CERTIFIES: <br /> 1. T ha#helshe has read all the provisos of this application,and that the description included in this application are correct to the best of <br /> hWbor l wledge,and <br /> 2. Thathe/she is the owner of the respective property;or is qualified to represent the owner;and <br /> 3: That,he/she wall.assume dull re <br /> sporsrili for all liability for persona;injury or damage to property which may arise out of the work <br /> above,;or wkrictt nyarout o#'hlher failure to do the work provided herein;and <br /> 4. That in the event any Claim of suchabitity is made against the Courcy 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 claire,and <br /> 5. That work shall be petforrned by the applicant andlor any representative of the application in the County Right-of-Way at the above <br /> indicated site with a valid Barr Jo uinnCounty l5noroachment Permit;and <br /> 6. That Up ermission is granted,as requested,he agrees to do the work described in accordance with all terms,condition and restriction <br /> Of this ar�d an aged sheet,incl asferal or special til provisions. <br /> 3v <br /> awe t to <br /> »»»»»»»»»»»»y»»»y»»»»»>FIELDIWA2ECtIO C MENTS<««««««««««««««««««««« <br /> 1. DRIVEWAY: None in ❑ Gravel ❑ Aggregate Base ❑ Paved(poor) ❑ Paved(good) ❑ <br /> 2. SLOPING:r IA Away from Pavement ❑ Towards Pavement ❑ Flat <br /> 3. PIPES: boneExisting,-y Type <br /> Other s in : Yes No > Approaches U Cross Drain U Size <br /> 4. HEADWALL: Yes ❑ No <br /> 5. ASPHALT CONCRETE DIKE: Yes ❑ No <br /> 6. BARRIERS. WMV,R�M "Way t, <br /> 7. DITCH. Yes arNo ❑ If Yes. V Style 2 ftnt ❑ Other ❑ Width 3 Depth <br /> »»s»»»»»»»»»»»»>>»»»»»»>»>>PER TS RI QUI€€ NT «««««««««««<<<<<< <br /> 1. DRIVEWAY: SFR ❑ Commercial ❑ Agriculture fl?"Industrial ❑ <br /> Pavedwith �' ' "Min Depth A.C.over "Min Depth 3/a"A.B.over <br /> Notes: <br /> 2. PIKES: Length of Pipe Required iy *` KJIA Ft.and Diameter of Pipe 0 1,01 inch(es) <br /> To be connected to any adjacent driveway pipe Yes ❑ No { , <br /> Drainage Inlet Required � r Yes ❑ No <br /> Total Length: -1/44 (with proposed) Total Number of Storm Drain Inlets: <br /> Notes: <br /> 3, HEADWALL: Yes ❑ No f <br /> 4. PAVED FRONTAGE: Paved with ° -Min Depth A.C.over Min Depth 3/4"A.B. <br /> Measuring Feet in length and Feet in width <br /> »»»»>>»»»»y»»»»»»»>»»»»»»>y»»»FEES«««««««<««««<c««««««««««««««< <br /> Driveway Encroachment Permit base feeV61 _. <br /> 06 <br /> Field Inspection <br /> Driveway w1 or w/o pipe ❑ Paved Frontage $108.00+0.501ft. <br /> Driveway wlbox Culvirrt 0 Curb,Gutter,Sidewalk $105.00+1.03fft. <br /> •r vx�w+.a a rEn�a�ueut�aa�r vniv a�lob <br />