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1. That he/she has read all the provisions of thisq*fication,and that the dascriptiee included mi this application are correct to the bast of his/her <br /> knowlmdgq and <br /> 2. That he/she is the owner of the respective property,or is quffiiedto represent theowne,and <br /> 3..That whe will assume full qty for all.liability for personal.injury or damage to property which may arise out ofthe work described above, <br /> or which may arise out of hister failure to do the work provided herein;and <br /> 4. That in the overt any claim of Such liability is made ageimtt to Coady of San hagivm or any oStciai or employee thereof,be shall <br /> defend,indemnify and holdthun and each of them harmless for such clam and <br /> S. Tbat work shall be pwfarmred by the applicant and/or any retro of the applicant in the County Right-of-Way at the above indicated site <br /> with a valid San Joaquin County Encroachment Permit;and <br /> 6. That if permission is granted as requested,be agrees to do the work described in acoordance with alt terns,oonditions and restriction ofthis and any <br /> attached cheek included as general 6r <br /> 3iguset�eo€ttppli�a�-Titus Dt. <br /> FIELD INSPECTOR COAMUMTS <br /> »»»»»»»»»»»»»»»»»}»»EMSIMgG CONDMON3«««««««««««««««««««« <br /> L DRA WWAY: None ❑ Int Gravel ❑ AggiregateBase ❑ Pavw*oc) ❑ Pav*Good) ❑ <br /> 2. SCOPING., Aiay!mm Pavement Towards Pavement ❑ Flat ❑ <br /> 3: PIPES:. Now 4.4^J�� Exkft-Type <br /> Odmrp4=innei6bodK*d: Yes ❑ No Approaches Crow Drain ❑ Sim C� <br /> Attachmeat to neighbor`s pipe: Yes ❑ No <br /> 4. HEADWALL: Yea .❑ No' <br /> S. ASPHALT CONCRETE 1)UM.- Yes ❑ No <br /> 6..BARRIERS ataugR*-c&Way <br /> 7. DP!'CS Yea ❑ No IfYes V Style ❑ 2 Point ❑ Other ❑ VrW& Depth <br /> PERMIT REQUIREMENTS<z««««««««««««««««««« <br /> 1_DRl[VEVf�AY: SFR COMMERCIAL. ❑ AadcULTU E ❑ INDUSTRIAL .❑ <br /> PAVED with Min.Depth Aa over. � "11dm.Depth 3/4"A.S. <br /> Notes <br /> 2. ]FRES: Y,calh of Pipe Req*o&' Fk and Diaffie6er of Pipe Each <br /> To be connected to any adjacw driveway pope Yes ❑.No — <br /> DRAINAGE INLET REQUIRED Yea ❑ No <br /> Tow (with Proposed) Total.N Wkr of Stwi:Dnin Meta. <br /> Notes <br /> 3. HEADWALL Yea Q No <br /> 4. PAVED FRONTAGE: PAVED with "Mia.Depth A.C.over "Mm.Depth 3/4"A.B. <br /> Mpg Feet im leng(h and Fed is width <br /> FRES <br /> Driveway Encroachment Permit:base fee..._.........._... ..... <br /> 5 <br /> F Inspection <br /> ewayw/ _$ <br /> 95_ ❑Paved frnrrtaga __. _ ..__ S100 00+0.46f& <br /> ❑Drivewayw/boxCulvert�.._. »... ._ ... ....»_.SiS5.00 ❑CurtyGutter,Sidewalk.........:....—.3100.00+0.981ft <br /> CcantalComputer,c:lAoceseVpplioation for PemitslDrigeway and Paved Frontage Page.2 cf 2 Revised=000. <br />