Laserfiche WebLink
THE AppLICANT BEREBY CERMUSs and that$he irci' w inthis application ate corned to the best of bis/her <br /> 1. That he/she has read all the provisions of this appEc ation, description <br /> knowlwdge;and <br /> 2. That helshe is the owner ofthe respective property,or is qualified to repro the owner;and <br /> 3. That he/she will„-WO full re b1W for alt liability fir personal-jury,or damage to Prop'vdu&may arise out ofthe work described above, <br /> or which may atise out of his/her failure to do the work provided hack;and <br /> 4. That in the event any claim of such liability is made against theCanty of Sm Amgiva or any department official or eMpjojee thereof;be shall <br /> defend,indemnify and hold dm and each of thern harmless far such clam and Wa at the above indicated site <br /> S. That work shall be performed by the applicant and/ofsay mpresentati"of the applicant in the Coudy Right Y <br /> with a valid Sea Joaquin County Fncroadsmmd Permit;and <br /> 6. That if permission is grantli as requested,he agrees to do the work described is aoomUnce with all turns,conditions and restriction.of Osis and any. <br /> attacked general or III pmvisiam ti <br /> ofAppTitle <br /> Date <br /> FIELD INSPECTOR COhgdRNTS <br /> >>>>>>->>>>>>>>>>>>>>>>>>,,.>>>>>>>>>>>>>>>EXISTING COMMONS««««««««««« < < <<««« <br /> L DRA TWAY: None ❑ Ditt (� Gravel ❑ Aggrogete Base ❑ Paveop") ❑ Paved(Good) ❑ <br /> 2. SLOPING: Away from Pavement [ Towards pavement ❑ Flat ❑ <br /> 3. PIPES: Now ,® Exilft-TYPO <br /> 0113,apipminnei&borhood: Yes ❑ No Approaches ❑ Cross Dram ❑ Size <br /> Attar to naghboes pipe: Yes ❑ No Q <br /> 4. HEADWALL: Yea ❑ No <br /> S. ASPHALT CONCRETE Dldl�:' Yes ❑ No <br /> 6..BARRIERS ak"Right-of--Way <br /> 1. DITCH Yes ❑ No If yes: V". ❑ 2 Floret ❑ O&W ❑ Width Depth <br /> >>>»>>>>>»>>>>>>>>» >PERS REQUIREMENTS«««««««««««««««««««« <br /> 1. DRIVEWAY: SFR [l� COMIWERCIAL ❑ AGRICULTURE ❑ INDUSTRIAL ❑ <br /> PAVED with Z "Mm.Depth A.C.over M.Depth 3/4"A.& <br /> Nates <br /> 2. PIPE& Laub of Pipe Requitod: Ft.and Diameter of Pipe Inch <br /> To be corrected to any a4acerd driveway pipe Yes ❑ No <br /> DRAINAGE INLET REQUIRED Yes ❑ No IF <br /> ToW Tom: (widhproposed) Total Number of Storm Draft Islets <br /> Nates <br /> 3. HEADWALL Yes ® No . <br /> 4. PAVED FRONTAGE: PAVED with "Mm.Depth A.C.over "Mm.Depth 3/4"A.B. <br /> Measuring Fed in tmg&and Feet in width <br /> FEW <br /> Driveway Encroachment Permit base fee............................$85.00 <br /> Field Inspection <br /> Driveway w/or W/o pipe.......... .._._.... .. ._... _ ..S9S_00 ❑Paved frmbV ... ....._..__....S100.00+0.46/R <br /> ❑lkiveway w/box C�rlvert._.. . _.. ._...__.._.._..5135.00 ❑curb,Gutta;Sidewalk.......................$140.00+0.98/R <br /> Revised 812000 <br /> Cou»takComputer,c:lAccessXApphcation for Pernuts0riveway and Paved Frontage Page.2 cf 2 <br /> i <br />