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THEPt rQW KRE8�GEKn S. <br /> 1 of hs a ftae description included in this application are correct to the best of <br /> ��"1ft1L��ei <br /> 2: `t'hat hem is the owrw 4f the respective property,or.*,died to represent the owner;and <br /> 3.: That I�she ares)asstt l respo ibiK fora for arta;injury or damage to property which may arise out of the work <br /> des�d ve;or�miy arse out of shier(ar urs to the wok provided herein;and <br /> 4. Thatthe eve a irrrr t3€ouch is ma le against Joaquin or any department,official or employee <br /> thereo€;he sh ,in y.at�d kms' artd Ott t fern harmless for such claim;and <br /> 5. That wO*-sW, perkO*by the r t a cl/or a€ty r eser tact a of the application in the County.Right-of-Way at the above <br /> in <br /> srte ►ith a vat San,fooagi Com Etoctc#'rrnerttrmit;and <br /> 6. That . granted as requested,1te.,Ww to dot work dWribed in accordance with all terms,condition and restriction <br /> of this and any{ Wit,inckKUX,J a$gerelat or special tit provisions. <br /> Signature of Appricaftt T156 Date <br /> }y}}?}}}}*y� ,}or a>;`?>?�"rb.`t9 »? >3?3►'A>?}}>�� .,A <<<<<<««««««««««««««««««< <br /> 1. DRIVEWAY: Nam ❑ 'Dirt,e Gravel ❑ A`PPOSe ,❑ Paved.(poor) ❑ Paved(good) <br /> 2, SLQPINO;* Away from Pavement'❑ Towards Pavement ❑ Ftat� <br /> 3. PIPES: None ❑ . 7T . <br /> Apotoaches M, Gross brain LJ Size <br /> 4, HEADWALL: Yes ❑ <br /> 5, ASPHALT Cf}I+ECI Yes 0 No <br /> 6. BARRIERS: altg Rht- #Wayy <br /> 7. DITCH: Yes ❑ No"E 1f Yes: V Style 2 Point ❑ Other Q Width Depth <br /> }}}}>3}}}}} } y}>>>,>>>>>>>>>,�-»»}>»>>»>»> TS RKUWMOM<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<< <br /> 1. DRIVEWAY: SF]14g, Commercial ❑ Agriculture ❑ Industrial ❑ <br /> Paved with "lam Depth A.C.over "Min Depth NO A.B.over <br /> A y <br /> Notes: <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 <br /> Drainage Inlet Required YesNo <br /> Total Length: (with proposed) Total Number of Storm Drain inlets: <br /> Notes; <br /> 3. HEADWALL: Yes ❑ No <br /> 4. PAVED FRONTAGE: Paved with "Min Depth A.C.over "Min Depth 3/d"A.B. <br /> Mewring' Feet in length and Feet in width <br /> »»»»»»}>>>>>>>>:>>»}»'>>'»»>>a» »}»>>>>FEES««««««««««««««««««««««««««« <br /> Driveway Encroachment Perrnit base fee $90.00 <br /> Field Insoaction <br /> D�iveway wl or w/o pipe $102. R.Curb, <br /> Paved Frontage $108.00+0.50/ft. <br /> Driveway w/box Cuiveat .00 Gutter,Sidewalk $105.00+1.03/ft. <br /> V iR1FA44 A TEMP ATV1;1rm 4"r!`"m1r PrAw nmv;waV MIARIrot <br />