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TUC Anni It-AMT UCOCov nc�f�TICICO. <br /> nrr�ivniv i � u i i�. i CE i ii lE <br /> t. That he/she has read all the provisions of this application,and that the description irre in t# <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 will assume full responsibility for all liability for persona;injury or damage to property which may s' <br /> described above,or which may arise out of his/her failure to do the work provided here lrr;and <br /> 4. That in the event any claim of such liability is made against the County of San Joaquin or any mei , <br /> thereof,he shall defend,indemnify and hold them and each of them harmless for such <br /> 5. That work shall be performed by the applicant and/or any representative of the appflgl}on!n the <br /> h. <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 a#tem,, <br /> of this and any attached sheet,included as general or special III provisions. <br /> Lure of Ap cant itle , <br /> »»»»»»»»»»»»»»»»»»»»»>FIELD INSPECTION COMMENTS«««<<<<<«««C«<c„KV, ¢ �t<<.,, << <br /> EXISTING CONDITIONS <br /> 1. DRIVEWAY: None ❑ Dirt ❑ Gravel 09--"Aggregate Base <br /> ❑ Paved{poor} ❑ Paves a <br /> 2. SLOPING: Away from Pavement ❑ Towards Pavement Flat <br /> s „ <br /> 3. PIPES: None 'Existing—Type <br /> Other pipes in neighborhood: Yes Na LVI Approaches Gross Drag <br /> 4. HEADWALL: Yes ❑ No [ <br /> 5. ASPHALT CONCRETE DIKE: Yes ❑ No <br /> 6. BARRIERS: along Right-of-Way /i) <br /> 7. DITCH: Yes ❑ No !f Yes V Style ❑ 2 Point ❑ Other ❑ Width <br /> »»»»»»»»»»»»»»»»»»»»»»»»PERMITS REQUIREMENTS<<<<<< <br /> 1. DRIVEWAY: SFR [i'Commercial ❑ Agriculture ❑ industrial ❑ <br /> Paved with "Min Depth A.C.over "Min Depth W A,B.oder <br /> Notes: 0� 'ea <br /> 2. PIPES: Length of Pipe Required ?./,% ~ Ft.and Diameter of Pipe des} <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. <br /> P over "Min Death Via"A.B. <br /> Measuring Feet in length and Feet in width <br /> >»»»»»»»»»»»»»»»»»»»»>»»»»»»FEES««««««««««<r««<c«<<<"< �««. <br /> Driveway Encroachment Permit base fee7/Gie►.=° # 06 <br /> Field Ins ection 6- o0 <br /> 2a <br /> Driveway wl or w/o pipe rt02TI7 Paved Frontage <br /> Driveway w/box Culvert 3167.00 ❑ Curb,Gutter, Sidewalk $10$.tX1 00.50M.$105.00+1,M,t. <br /> YiFORMSB iEA:P�iE�e'MCROnCHIdE•.'PER•AIT CRb 'AY ticc;,g'rp; <br />