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1�a R,L'lirlua.ru�i aiuiu....a. s . <br /> 1. That he/she bas read all the provisions of this application,and that do descriptio®mchaded laths application am correct to the fest of hs/her - <br /> fsnowhvdge;and <br /> 2. That he/she is the owner ofthe respective property,or is qualified to rpt the ovine,sad <br /> 3. That he/she will assume fall responsibility fir aft liability for personal injury damage to property which may arise out ofthe work described above, <br /> or whichmay arise out of his/her failure to do the wick providedhumn;and <br /> 4. That in the event any claim of each liability is made against theCowly gSan)oagiaa or Bay depe Wwak offiddt or employee lba+eg he shall <br /> defend,indeumW and hold&=and each of tbam harmlessfor such claim;and <br /> S. That work shall be pmfaamed by the applicant and/or any nape iVe of the <br /> applicant in the County Riglrt-of-Way at the above.indicated site <br /> wish a valid San Joaquin County Fit Pernhi;and <br /> 6. That if pen nission is granted as regws t4 he agrees to do the wads described in <br /> accordance w tlth alt <br /> teens,conditions and restaction ofibis and any: <br /> dbctad sheet,included as anneal ohat <br /> Sigoatmv ofApplicaut-Tithe <br /> FIELD INSPECTOR COMMWM <br /> »»»»»»»»»»»»»»»»»»»»EXiS'i'M CONDITIONS««c«««««««««««««««««< <br /> } <br /> L DRIyEWAY: None 0y <br /> Dirt ❑ clravoet ❑ Aggregate Base O Pavea(pow) C7 Paved(flood) ❑ <br /> 2.SLOPING: Away&vm Pavan-A ❑ Tow &PaV..* Flat ❑ <br /> I PIPES:. None ❑ Exuding-Typg <br /> Odmr piPm in odood: Yes ❑ No Approaches E Crow Drain ❑ Size <br /> Aifsclunentto newwo Yea ❑ No <br /> 4 HEADWALL: Yes ❑ No ' <br /> S. ASMALT CONCRETz DIKE:' Yes ❑ No <br /> G.BARRUM atongRigbt cMay <br /> �. DTTCS Yes ❑ No es: V Style ❑ 2 Feint ❑ Odlw ❑ Widfh Dq)th <br /> »»»»>.»>PERMITREQUMEMENTs«««««««««««««««««««« <br /> L DRIVEWAY: SFR COMMERCIAL ❑ AGRk:ULTU" ❑ INDUSTRIAL ❑ <br /> PAVED with R Ifia.Depth A.C.over 4 "Mn.Depth 3/4"AR <br /> Nates <br /> 2. PIPZ& L.eng0l of Pipe Rem• Pt.and Diandeter of Pipe -- -- inch <br /> To be connected to any adjacent driveway pipe Yee q❑ No f1i <br /> DRAIMAt3E INLET REQUIRED Yee ❑ No <br /> Todd L aOg& (with pry) Total Number of ftem:Dnk faints <br /> Nates <br /> 3. 1MADWALL Yee ® No <br /> 4. PAVED FRONTAgE: PAVED with "Mm.Depth A.C,over "Mia.Depth 3/4"A.R <br /> Mpg Feet in tang&and Feet in width <br /> lirS.F.S <br /> Driveway Encroachment Permit base fee_..................... <br /> Fneldlnspection <br /> ❑Driveway w/or W/o pipe.......... .. _ _ _ 595-40 ❑.Pavedfhnute.._...._.....:._._...___.S100.00+0.46/& <br /> ❑Driveway w/box Cntvat—. __.... .;._.5151.00 00+ <br /> CouatakComputer,c:U-cesa\,Apptioatioa for ParmitslDriyeway and Paved Frontage Page.2 cf 2 <br /> Revised 8/2000. <br /> i'� <br />