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1. ftprovtskx►s of this application,and that the description included in this application are correct to the best of <br /> 2 Tt #*€ pective prr,+petty,or is grimed torepresent the owner;and <br /> 3- ,;' W, 4*, q," *responsibluty for all liability for persona;injury or damage to property which may arise out of the work <br /> o <br /> r, � �out of tiis�her fa�0re to do the work provided herein;and <br /> 4: oi�wt* of suofi�liability is made against the County of San Joaquin or any department,official or employee <br /> - j;;and hold them and each of them harmless for such claim;and <br /> 5. ,by the,applicant aridbr any representative of the application in the County Right-of-Way at the above <br /> in ` s t p Jpaqlairr County Encroachment Permit,and <br /> 6. pe€€n r te,he agrees to do the work described in accordance with all terms,condition and restriction <br /> 1Ii.4 ark y " irtd�as general or special 111 provisions. <br /> nt Ttle ate <br /> «««««««««««««««««««««< <br /> �S`f'ttVt�`i CC�a� S <br /> 1. DRIVEWAY Nom-[] D Gm* © Aggregate Base Paved(poor) ( " Paved(good) <br /> 2. SLt)PtN .�1*v o Q Towards Pavement Q Flat <br /> 3. PIPES- <br /> YesU No Approaches Cross Drain CT Size <br /> 4,AMWALL Yes,01 <br /> S. ASPHALT ObWJMMYes. <br /> 6AARRIERS: oaf-day <br /> 7, DITCH: Y4W t N Y€§: V Style rJ 2 Point Q Other ❑ Width Depth <br /> >>>>>>>>>>>>>>>>> ;>00,>>>>>�>»»»»»»>>>>P RWM REGil WENTS<<<<««««««««<««««««««««< <br /> 1. DFttVEWAY: coir e€ds,1 Agriculture E] Industrial ❑` <br /> Paves w#h "Min Depth AC.over 4P "Min Depth Ntm A.B.over <br /> Notes: <br /> 2. PIPES: Lend of F"fired Ft.and Diameter of Pipe inch(es) <br /> To be eor cted,to any adjacent driveway pipe Yes ❑ No <br /> D€ "e Intet Floquired Yes 0 No <br /> Total t,� (with proposed) Total ber of Storm Drain Inlets: <br /> Notes: <br /> 3. HEADWALL Yes 0 No <br /> 4. PAVED FRONTAGE; Paved with "Min Depth A.C.over °Min Depth 74'A.B. <br /> measu€fng> Feet in length and Feet in width <br /> »»>a»»>y»»»>->»»»»>>>s»»»»»>»»»>s»>FEES««««««««««««««««««««««««««« <br /> Driveway Emroasthtnert Permit bass fee _$90.00 <br /> Fre 1 <br /> Dilveway w/or wto pipe $102.00 8Paved Frontage $108.00+0.50/ft. <br /> Driveway w)box Culvert $167.00 Curb,Gutter,Sidewalk $105.00+1.03/ft. <br /> YAF0"4 TEk"ATL3'�N=ACHk*NTf*RW Oi%WAY;4MMM6) <br />