Laserfiche WebLink
THE APPLICANT HEREBY CERTIFIES: <br /> 1. That he/she has read all the provisions of this application,and that the description included in this application are correct to the best of his/her <br /> knowlwdge;and <br /> 2. That he/she is the owner of the respective property,or is qualified to represent the owner;and <br /> 3. That helshe will assume full responsibility for all liability for personal injury or damage to property whichmay arise out of the wodk 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 JDagi n or any depatt meet,official or employee thereof;he shall <br /> defend,indemnify and hold them and each of them harmless for such elairn;and <br /> 5. That work shall be performed by the applicant and/or any representative of the applicant in the County Right-of--Way at the above indicated site <br /> with a valid San Joaquin County Encroadmient Perim and <br /> 6. That if permission.is gloated as requested,he agrees to do the work described in accordance with all terms,conditions and restriction of this and any, <br /> attached shee as geaerat III provisions. <br /> p ?� <br /> SignatrseofApplicanl=Fill Date <br /> FIELD INSPECTOR COAKdFNTS <br /> »»»»»»»»»»»»»»»»»»»»EXISTE40 CONDMONS«««««««««««««««««««« <br /> 1. DRIVEWAY: None ❑ out ` Gravel ❑ Aggregate Base ❑ Pav.") ❑ Paved(Good) F-1 <br /> SLOPING: Away from Pavement E] s <br /> Towadpavemam El Flat <br /> �; <br /> 3. PIPES: Now ❑ Existing-Type <br /> Other pipes in neighborhood: Yes No ❑ Approaches '\ Cross Drama ❑ Size <br /> Attachment to neighbor's Yes ❑ No <br /> 4. HEADWALL: Yes ElNo' <br /> S. ASPSALT CONCRE'T'E DWI: Yes ❑ No <br /> & BARRIERS along Rigbt-af.Way <br /> 7. DITCH Yes 0 No ❑ IfYes: V Style 2 Point ❑ Othw ❑ Width Depth <br /> »»»»>>>>> »»»»»»»»»»PERMIT REQL4 EMENTS«««««««««««««««««««« <br /> 1.DRIVEWAY: SFR COMMERCIAL. ❑ AGRICULTURE ❑ INDUSTRIAL ❑ <br /> PAVED vxith Mia Depth A.C.over <br /> lvtm Depth 3/4"A.B. <br /> Notes <br /> 2. PIPES: Lae.gth of Pipe Required: Ft and Diamda of Pipe Inch <br /> To be connected to any adjacent driveway pipe Yes ❑ No <br /> DRAINAGE INLET REQUIRED Yes ❑ No <br /> Total Length: (with proposed) Total Nurrher o[Storm Drab Inlets <br /> Nates <br /> 3. HEADWALL Yes ® No <br /> 4. PAVED FRONTAGE: PAVED with "11Sm Depth AC.over "Min.Depth 3/4"A.B. <br /> Measuring Feet in kngth and Feet in width <br /> FEES <br /> Driveway Fnc roaclm>ent Permit base fee........................._.$85.00 <br /> Field ou <br /> Driveway w/or w/o pipe..............................._......__._..$95.00 ❑Paved&rootage ._. S100.00+0.46/ft <br /> ❑Driveway w/boxCnlveR........................................._..$155.00 ❑Curb,Gutter,Sidewalk....._..._........$100.00+0.98/8 <br /> Counter\Computes,6Access\Application for Permits0rmveway and Paved Frontage Page.2 of 2 Revised 8/2000 <br /> i <br />