Laserfiche WebLink
THE APPLICANT HEREBY CERTIFIES: <br /> 1. That hedshe has read all the provisions of this application,and that the description inched in this application are correct to the best of his/her <br /> knowltvdge,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 fall responsibility for all liability for personal injury or damage to property whichmay arise art of the work described above, <br /> 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}'Darius or any department,official or enpk*w th=4 he shall <br /> defend,indemnify and hold them and each of them harmless for Rads claim;and <br /> 5. That work shall be performed by the applkant and/or any representative of the applicant in the Comity Right-of-Way at the above indicated site <br /> with a valid San Joaquin County Encroacbnent Pit;and <br /> 6. That if permission is gamed as requested,he agrees to do the work described in accordance with all teens,conditions and restriction of this and any <br /> attar d sheet,included as general cr special III provisions. <br /> Signature ofApplicrmt-Title Date <br /> FIELD INSPECTOR COMMMTS <br /> »»»»>WMTM CONDITIONS«««««««««««««««««««« <br /> 1. DRIVEWAY: None ❑ Did Gravel ❑ Aggregate Base ❑ P- ) ❑ Paved(Good) ❑ <br /> 2. SLOPING: Away fivin Pavement ❑ Towards Pavement ❑ Flat <br /> 3. PIPES: None Existing-Type <br /> Other pipes in neighborhood: Yea No ❑ Approaches ❑ Cross Drain ❑ Size <br /> Affadanenl to aeigbbor's Yes ❑ No <br /> 4. HEADWALL: Yes ❑ No <br /> 5. ASPITALT CONCRETE DIICE: Yes ❑ No <br /> 6. BARRIERS along Right-4-Way •lam <br /> 7. DITCH Yes A� No g If Yes: V We ❑ 2 Point ❑ Other ❑ Width Depth <br /> »»»»»»»»»»>»»»»»»»»»>PERMIT REQUIREMENTS«««««««««««««««««««« <br /> I.DRIVEWAY: SFR 4 COMMERCIAL [❑ AGRICULTURE ❑ INDUSTRIAL ❑ <br /> PAVED with Z "Min.Depth AC.over <br /> �_"Mia Depth 3/4"A.B. <br /> Notes 777TGN B/I� <br /> /� Siler, ,Su7'NdT e7/l/ SC�IrYl�T�s� <br /> 2. PIPES; Largth of Pipe Required: Ft.and Diameter of Pipe Lich <br /> To be connected to any adjacent driveway pipe Yea ❑ No <br /> DRAINAGE INLET REQUIRED Yes ❑ No <br /> Total : (with propowd) Total Number of Storm Draho bdeft <br /> Notes <br /> 3. HEADWALL YeS ® No <br /> 4. PAVED FRONTAGE: PAVED with Min <br /> Depth A.C.over "Mia Depth 3/4-A.B. <br /> Mpg Feet in length and Feet in width <br /> FEES <br /> Driveway Encroachment Pewit base fee............................$95.00 <br /> 9d Inspection <br /> Driveway w/or w/o pipe............................... ..............$95.00 ElPaved <br /> frmtage..._.........._.___..........$100.00+0.4641 <br /> Driveway w/box Culvert.......................................: .$155.00 ❑Curb,Gutter,Sidewalk.......................$100.00+0.98/ft <br /> CountaAComputer,c:lAccess\Application for Permits0riveway and Paved Frontage Page 2 of 2 Revised 8/2000 <br />