Laserfiche WebLink
j rY H,AC.CJstt.tkl.�s i r.•.aa�:.0 a. a.rsaasaa•ease. <br /> 1. That he/she has read all the provisions of this applicatioq and that the dumipfim kduded in this application an cowed to the best of Ws&w <br /> knowhrdge;and _ - <br /> 2. That he(she is the owner of the respective property,or is qualified to resat tits owner and , <br /> 3. That he/she will assume fall city for all.liability Sar pasond injury or damage to property whichmay arise out ofthe work described above, <br /> or which may ansa out of W&lw faifur+e to do the work provided haaer,and <br /> 4. That in the event any claim of such liability is made against OwComrty of San Jbacjttn or arrydepartnaent,atlfidd or employeo ihftwo be shall <br /> defend,indemnify and hold*cm and eadt dthent harmless.for such daaq and <br /> S. That work shall be perhaned by the aWficexlt and/or say repr+esci tete of&e applicant in the Canty Right-of-Way at the above indicated site <br /> with a valid San Joaquin County E=oadn3a t parmit;and <br /> b. That if permission is granted as requested,Ire agrees to do the wodc described is accordance with alt terns,omditioas and mtriction ofibis and any <br /> attached shunt,iaduded as 9amerapecidi4covis,000. <br /> sigrrataae of Tilt. Daft <br /> FEKLI)INSPECTOR COMMUM <br /> »»»»»»»»»»»»»»»»»>}»»EXisuNa CONDTITONS«««««««««««««««««««« <br /> L DRA%WAY: Naos pat ❑ Q-vel ❑ AMqpft Base ❑ Paved(poar) ❑ Paved(Good) ❑ <br /> 2.SLOPING: Ay f..Pavama t � Towards Pavement ❑ Fist ❑ <br /> 3.PIPES:. Now Etdsting-Type <br /> Odwpipesinneighbod wod: Yea ❑ No Approsdtes ❑ Cron Dram. ❑ sire <br /> Attachmeettoneigbbot'a Yes ❑ No <br /> 4.HEADWALL: Yee ❑ No" . <br /> 1 le <br /> S.ASPHALT CONCRETE DIICL:' Yes ❑ No <br /> 6..BARRIERS along RigWa.Way <br /> 1. DTPCH Yes ❑ No ifyes:- V Style ❑ 2 Point ❑ Other ❑ Width Depth <br /> >»»»?»»»»»»»»»»»»»»»PSRMiTREQUIItEIdENTS«««««««««««««««««««« <br /> L DRIVEVfrA7C: SFR CObIDdERCIAI, ❑ AMCULTURt ❑ INDUSTRIAL ❑ <br /> PAVED with Z "Min.Depth A.C,over "ldm.Depth 3/4"A.B <br /> Nates <br /> 2. PIPM Leasok ofPip*Required: FL and Diameter of Pipe inch <br /> To 6e oaooeded to any adjaoatt driveway pipe Yes ❑ N <br /> DRAINAGE IN1ET REQUIRED Yea ❑ No <br /> Total LagL. (wilh proposed) Total N>mther of Stem:Drmha Itdets <br /> Nates <br /> 3. HEADWALL Yee Q No <br /> A PAVED FRONTAGjE: PAVED with "Min.Depth A.C,over "Mia Depth3/4"AB. <br /> Measuring Feet is length and Feet is width <br /> FENS <br /> Driveway Fnmoac hmeut Pamit base fee_.......................t <br /> Fr on <br /> y w/err w/o plea......... _._.._ .._ ❑Pavod ftoadage _. _ . _ ..__ S100 00+0.46f& <br /> Drivewayw/boxCalveR_. ..__ .... .._.. . .. .. .._.Si35.00 ❑Curb,Ontta;Sidewalk....:..................$140.00+0.98/ft <br /> CouritakComputa;c:lAcc=VPplioaiioa for Pern>WDoymay sad Paged Frontage Pagel of 2 Revised 8/2000 <br /> R.� <br />