Laserfiche WebLink
THE APP ISTHEREBY:CERTIFIES: <br /> 1. That haf he 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 Wshe is the owner of the respective property,or is qualified to represent the owner;and <br /> 3. That heishe 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 applic or any representative of the application in the County Right-of-Way at the above <br /> indicated site with a valid San Jc�taqul un ty En oachment Permit;and <br /> 6. t if permission is granted equested,he agr es to do the work described in accordance with all terms,condition and restriction <br /> #this and any atta t i ,inelttded as ge I or special 111 provisions. i <br /> 'l 1 _ <br /> ignature Applicant Title tate <br /> »»»»»»»»»»»»»»»»»»>FIELD INSPECTION COMMENTS«««««««««««««««««««««< <br /> EXISTING CONDITIONS <br /> 1. DRIVEWAY: None (Dirt ❑ Gravel ❑ Aggregate Base ❑ Paved(poor) ❑ Paved(good) ❑ <br /> 1. J",' <br /> 2. SLOPING: Awy#om Pavement Towards Pavement ❑ Flat <br /> 11 <br /> 3. PIPES: None Existing—Type <br /> Other pipes in nelghborh&d7Ye_s_[T__N_o_0 Approaches LJ Cross Drain LJ Size <br /> 4. HEADWALL: Yes ❑ No <br /> 5. ASPHALT CONCREt,DIKE. Yes,❑ No +1 <br /> 6. BARRIERS: along Right-of Way <br /> 7. DITCH: Yes ❑ No f Yes: V Style ❑ 2 Point ❑ Other ❑ Width Depth <br /> »»»»»»»»»»»»»»»»»»»»»PERMITS REQUIREMENTS««««««««««««««««««««« <br /> 1. DRIVEWAY: SFR Commercial ❑ Agriculture ❑ Industrial ❑ <br /> Paved with "Min Depth A.C.over "Min Depth 3/4'A.B.over <br /> Notes: <br /> 2. PIPES: Length of Pipe Required 'r ` 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 <br /> 4. PAVED FRONTAGE: Paved with "Min Depth A.C.over "Min Depth 3/4"A.B. <br /> d/,q Measuring Feet in length and Feet in width <br /> »»»»»»»»»»»»»»»»»»»»»»»»»»»FEES«««««««««««««««««««««««««<<<< <br /> Driveway Encroachment Permit base fee $80.00 <br /> Field Inspection <br /> Driveway w/or w/o pipe $102.00 ❑ Paved Frontage $108.00+0.50/ft. <br /> LJ Driveway w/box Culvert $167.00 Curb,Gutter,Sidewalk $105.00+1.03/ft. <br /> Y:VFOR4&TEMPLATESEMACW&NT PEFUT MVEWAY.d.PM) <br />