Laserfiche WebLink
THE APPLICANT HEREBY CERTIFIES: <br /> 1. That he/she has read aU the provisions ofthis apowstion,and that the description kAWed iuthis <br /> appluxtion ate ooffectto the best ofhis/her <br /> knowlwdge;and <br /> 2. That he/she is the owner of the eveproperty, is alifiedto represent theowrsery and <br /> 3. That he/she will assume full responsh7ityi fox all tialaity for personal injury or dan Cage to property which may arise out of the work desm'bed above, <br /> or which may arise out ofhis/her faihm to do the work provided herein;and <br /> 4. That in the event any claim of such liability is made against theCoundy of San Aoagim or any official or <br /> _ employee thereat he shall <br /> defend,indemnify ad holdthem and each of them harmless for such clammy and <br /> 5. That work shall be performed by the applicant and/or any representative of the applicant in the Cowry Rigit-of Way at the above indicated site <br /> with a valid San Joaquin Camay Encroadm>eot Pemat and <br /> b. That if perwission is granted as requested,he to do the wank described in accordance with all <br /> agroes tensa,oanditims and t+esttictian of this and any <br /> attached sheet,induced as genera(br special III provisions. <br /> S*mtme ofApp}icxrt-TM& Date <br /> FIELD INSPECTOR COMMF,NTS <br /> »»»»»»»»»»»»»»»»»»»>EM STRgGCONDITION S«««««««««««««««««««« <br /> t <br /> L DRIVEWAY: Nene & Dict ❑ (3ravet ❑ Aggregate Baso ❑ Paved(poor) ❑ Paved(Good) ❑ <br /> 2. SLOPING: AwayfimrPavemen ❑ TowardsPawmem ( Flat ❑ <br /> 3. YVES.-. None Ar—, ErA -Type <br /> Other pipes inneighbadmiod: Yes ❑ No Appmacim ❑ Crm Drain ❑ <br /> Attachment to neighbor's pipe: Yes ❑ No <br /> 4. IMADWAId.,: Yes ❑ No , <br /> fi. ASPHALT CONCRETE DIKE: Yes ❑ No <br /> G.BARRIERS along Right-a£Way <br /> 7. wrm Yes ❑ No A Ifyes:- V Style ❑ 2 Point ❑ Other ❑ W-,M Dept <br /> PERMITREQUiR.EMENTS<z«««««««««««««<<< << <br /> 1.DRIVEWAY: SFR CObII1dERCIAL ❑ A I inRfCULTURE ❑ INDUSTRIAL ❑ <br /> PAVED with Z "Ithm.Depth A.C,over "AfmL Depth 3/4"A B <br /> Nates <br /> 2. PIPS& Leers of Pipe Re"kedt- Ft.and Dim ater of Pipe Inch <br /> To be connected to any adjacent driveway Pape Yes ❑ No — <br /> DRAINAGE INLET REQUIRED Yea ❑ No <br /> Tow Law& (with proposed) Totaliii"'"'N"""umber of Shurwr Dtsim bdets <br /> Notes <br /> 3. HEADWALL Yes ® No <br /> 4. PAVED FRONTAGE: PAVED with "hfim.Depth AC.over "Mm Depth 3/4"A.B. <br /> Measuring Fed ift lemig4lr and Feet in width <br /> FEES <br /> Driveway Enc oachmead Permit base fee...........................$85. <br /> M Inspxtion <br /> away w/or w/o pipe....._.......... ._._.:. __ _S9 ❑Paved fiststage..._...._.....:..._...._......S100.00+0.46fR <br /> ❑Driveway w/box Culvert._. ._ _......__.................__- 155.00 ❑Cunt,t3uuey SidevvaDc...................$10o.00+0.98/R <br /> Cwmtet{Comp dw,c:Wccesa\Application for Permit Ml yeway and Paved Frontage Page.2 of 2 Revised 8/2000 <br /> i <br />