Laserfiche WebLink
TIM APPLICANT HEREBY CERTIFIES: <br /> 1. That he/she has read all the provisions of this apgfication,and that the description inchded Mid&- application are correct to the best of his/her <br /> knowlwdge,and <br /> 2. 'That he/she is the owner of the remove property,or is VWified to reset the owner;and <br /> 3. That he/she will as==fall responsibility for all liability far personal iugury or damage fin property which may arise out oftcri <br /> he work desbed above, <br /> or which may arise out of Mather failure to do the work provided herein,and <br /> 4. That in the event arty claim of such liability is made against tlteCounty of Sat)oagiun or any dept,official or empkoyea thereo&he shall <br /> defend,indemnify and holdthem and each of them harmless far such clam and <br /> 5. That work shall be performed by the applicant and/or any repreawtatiVe of the applicant in the COWRY Right-of-Way at the above indicated site <br /> with a valid San Joaquin County Encroachment Pew and <br /> b. That if per#ission is granted as requested,he agrees to do the wank degas'bed in ac oordamx with all trans,conditions and restriction of this and any <br /> attached t,included as or special III provisions. <br /> Sig ftreofApplicast-Title Date <br /> FIELD INSPECTOR COAdMENTS <br /> EXISTINO CONDPPIONS«««««««««««««««««««« <br /> L DRiVEWAY: Now ❑ Dirt , '� Grand ❑ Agg+rogate Base ❑ ❑ <br /> Paved(Good) E]3.SLOPING: Away&»rn Pavement ❑ Towards Pavamant E] Flat <br /> 3. PIPES- Now Existing-Type <br /> Other pipes in nd6borhtlood: Yes ❑ No Approaches ❑ Cross Drain ❑ Size <br /> Attar mwt to neighbor's pipe: Yes ❑ No k <br /> 4.HEADWALL: Yea ❑ No' X— . pp�� <br /> S.AWEL4LT CONCRETED Yea ❑ No, 0-1- <br /> 6..BARRIERS along Right-aff Way �� <br /> 1. DITCH Yes El No CZ- IfYos: V We ❑ 2 Point ❑ Other ❑ Width Depth <br /> »»»»»»»»»»»»»»»»»»PERLUTREQUIREMENTS«««««««««««««««««««« <br /> 1.DRIVEWAY: SFR COMMERCIAL ❑ AGRtCULTURE ❑ INDUSTRIAL ❑ <br /> PAVED with "Alin.Depth A.C.over "Mm.Depth 3/4"A.B. <br /> Now <br /> 2. PIPES: Laub of Pipe Ralniry - Ft.and Diameter of Pipe huh <br /> To becomacted to any adjacent driveway pipe Yes No Its <br /> DRAINAOE INLET REQUIRED Yes ❑ No <br /> tLl- <br /> TOW Length: (with proposed) Tota!Number of Storm Drada Islets <br /> Nates <br /> 3. HEADWALL Yes ® No k <br /> 4. PAVED FRONTAGE: PAVED with "Mm.Depth A.C.over "Him Depth 3/4-A.B. <br /> Measuring Feet in.length and Feet in width <br /> FEES <br /> Driveway Enuoaclm ent Permit baso fee..................... ....:585.00 <br /> XgdvFi 'on <br /> away w/or w/o pipe.............._....._ ....._...___. ..595. Elfrcma <br /> Paved tage.........-------..---..$100.00+4.46/& <br /> El Driveway /box Culvert._........................... ._. ❑curb,Gutta,SidewallL......................5100.00+0.98/ft <br /> C;ounteikC m V iter,c:\AccessVppliaation for PermitslDriveway and Paved Frontage PaW.2 of 2 Revised 8/2000 <br />